Original ContributionEpidemiology of elevated blood pressure in the ED☆,☆☆,★
Introduction
Hypertension is a common condition, affecting approximately 67 million, or 1 in every 3, American adults [1]. The prevalence of hypertension is estimated to increase by 7.2% by 2030 [2]. The annual costs of hypertension which includes health care services, antihypertensive agents and missed days of work is approximately $47.5 billion [1]. Undiagnosed, untreated and uncontrolled hypertension can lead to stroke, renal failure and cardiovascular complications. High blood pressure (BP) is prevalent in approximately 69% of patients who have a first myocardial ischemic event, 77% who have a first stroke, and 74% who have congestive heart failure [2]. Early identification and intervention can prevent many of the long-term hypertension-related complications [3]. Approximately 1 in 5 individuals in the United States are unaware that they have hypertension and remain undiagnosed [1].
Elevated BP is often noted in emergency department (ED) patients. According to National Hospital Ambulatory Medical Care Survey, 30% of patients seen in the ED have high BP (> 140/90 mm Hg) [4]. Many individuals with undiagnosed hypertension are evaluated in the ED for an unrelated illness, and the ED visit may be the only time their BP was measured. It has been well documented in the literature that a significant proportion of ED patients (26%-77%) with high BP are indeed hypertensive, with persistently elevated BP during outpatient clinic follow-up [5], [6], [7], [8], [9]. The variation in prevalence is likely due to differences in the study setting (ED vs ED and urgent care), and data collection procedures (electronic medical records vs. self-reported patient data) [8]. The ED visit presents a unique opportunity for identifying individuals with undiagnosed or inadequately treated hypertension, providing BP counselling and arranging a referral for reevaluation and intervention. The American College of Emergency Physicians 2006 Asymptomatic Hypertension clinical policy guidelines on the evaluation and management of adult patients with asymptomatic elevated BP in the ED recommends that emergency physicians provide outpatient referral to patients with persistently elevated BP in ED for reassessment [10].
EDs are a major source of health care in the United States. Therefore strategies to identify individuals with undiagnosed hypertension and provide appropriate interventions are crucial to reduce morbidity and mortality from uncontrolled hypertension. Knowledge of distribution of elevated BP in ED patients is useful for developing ED based interventions for hypertension. To our knowledge, no prior studies reported the prevalence of elevated BP in different age groups, ethnic categories, across different shifts, and severity of elevated BP in ED patients. The objective of this study was to determine the prevalence and demographics of elevated BP in ED patients.
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Study design/study setting
This retrospective study took place over a one year period at an academic medical center with approximately 44 000 annual ED visits. The ED was staffed by attending physicians who are board-certified or eligible in emergency medicine and had a 3-year emergency medicine residency training program. Patients presenting to the ED were evaluated by EM attending physicians and residents. An institutional review board approval was obtained for this study protocol.
Study population
The ED patient population was composed
Results
A total of 44 435 patient records were accessed. Overall 47.6% (95% CI, 47.2%-48.1%) of patients had elevated BP (SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg). Fifty three percent (95% CI, 52%-54%) were women. Among patients with elevated BP, 18% (95% CI, 17.8%-18.9%) had severe BP elevation (SBP ≥ 180 or DBP ≥ 110). Sixty percent (95% CI, 58.4% to 61.4%) of patients with severe BP elevation were women.
Among all women seen in the ED, 45% (95% CI, 44.5%-45.8%) had elevated BP. Twenty percent (95% CI,
Discussion
Our results suggest that high BP is widely prevalent in ED patients and a significant proportion of patients had severe BP elevation (SBP ≥ 180 or DBP ≥ 110). Elevated BP was noted in all ethnic groups and both genders with higher prevalence in white men. ED patients older than 45 years were more likely to have elevated BP. However, isolated DBP elevation was more common in individuals < 45 years. Across all ethnic groups, severely elevated BP was more often noted in patients older than 65 years.
Conclusions
This study provides knowledge of the distribution of elevated BP among different age, gender and ethnic groups in the ED. The findings may be used to develop specific interventions to improve recognition, prevention, detection, and treatment of hypertension.
Acknowledgments
The authors thank Valerie Shostrom and Ron Carson for their assistance with data collection and analysis.
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2021, American Journal of NursingAn Unmet Need Meets an Untapped Resource: Pharmacist-Led Pathways for Hypertension Management for Emergency Department Patients
2019, Current Hypertension ReportsHypertensive crisis: An update on clinical approach and management
2017, Current Opinion in CardiologyTrends in the incidence of hypertensive emergencies in us emergency departments from 2006 to 2013
2016, Journal of the American Heart Association
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Abstract presented at American College of Emergency Physicians Research Forum, Boston, Massachusetts-10/2009.
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Funding Sources: None.
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Disclosures: None.