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Use of the emergency department for hypertension screening: a prospective study
Insights
Emergency departments (EDs) can effectively screen for hypertension. Many patients identified with high blood pressure in the ED require further evaluation and treatment.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- Controversy exists regarding the suitability of emergency departments (EDs) for hypertension screening.
- Concerns include potential false elevations in blood pressure due to pain and apprehension during ED visits.
Purpose of the Study:
- To prospectively evaluate the efficacy of EDs as a screening site for hypertensive patients.
- To determine the prevalence of significant and borderline hypertension among patients identified in the ED.
Main Methods:
- Prospective screening of all patients admitted to a university hospital ED over one year.
- Follow-up was attempted for patients with specific elevated systolic or diastolic pressure criteria on admission and discharge.
- Blood pressure was reassessed during follow-up visits.
Main Results:
- Out of 239 eligible patients, follow-up was obtained in 45%.
- Significant hypertension was diagnosed in 35% of follow-up patients, and borderline hypertension in 33%.
- Pain levels did not significantly differ between normotensive and hypertensive groups.
Conclusions:
- The emergency department is a viable site for hypertension screening.
- Elevated blood pressure readings at ED discharge warrant referral for follow-up evaluation and management.
- A substantial proportion of patients screened in the ED are found to have hypertension requiring intervention.
Abstract:
There is controversy as to whether the emergency department is an inappropriate site for screening for hypertensive patients. The pain and apprehension associated with many ED visits have been thought to elevate blood pressure readings falsely in this setting. To resolve this question, all patients admitted to the ED of a university hospital during a one-year period were screened prospectively for hypertension. Follow-up was attempted for patients who, on admission and discharge, had systolic pressures higher than 159 mm Hg or diastolic pressures higher than 94 mm Hg. A total of 239 patients met these criteria, and follow-up was obtained in 45% of the cases. Significant hypertension (systolic greater than 159 mm Hg or diastolic greater than 94 mm Hg) was found in 35% of these patients on follow-up. Borderline hypertension (systolic, 140 to 159 mm Hg; or diastolic, 90 to 94 mm Hg) was documented in 33% of the patients. Thirty-two percent were found to be normotensive when evaluated in a follow-up visit. The number of patients experiencing pain at the time of their initial ED visit was similar among the three groups. Almost half the patients with hypertension on follow-up needed further workup or therapy. The ED can be a useful screening site for hypertension; elevated blood pressure on discharge should ensure referral for follow-up evaluation and therapy.