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Elevated Blood Pressure Among Military Emergency Department Patients
Joseph Rhee1, Tom Beltran2, Y Sammy Choi2
1School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, United States.
Insights
Elevated blood pressure (BP) is common in military emergency departments, often undiagnosed. Early detection and follow-up are crucial for managing hypertension and reducing cardiovascular disease risk.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Military Health
Background:
- Hypertension is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD).
- Limited data exist on hypertension prevalence in younger populations like military service members.
- Early detection of elevated blood pressure (BP) is critical for preventing long-term ASCVD.
Purpose of the Study:
- To determine the prevalence of elevated BP in active duty U.S. Armed Forces service members presenting to military emergency departments (EDs).
- To examine the relationship between elevated BP in EDs and subsequent hypertension diagnoses.
- To assess the diagnostic gap for hypertension in this population.
Main Methods:
- Retrospective analysis of outpatient medical encounters for active duty service members (January 2016-December 2022).
- Data sourced from administrative and electronic health records, including sociodemographic and occupational information.
- Multivariable mixed-effects regression analysis to identify factors associated with BP.
Main Results:
- 37.9% of the study population presented with elevated BP in military EDs, with only 3.4% having a prior hypertension diagnosis.
- At ED visits, 30.2% met Stage 1 and 7.7% met Stage 2 hypertension criteria.
- Within 12 months, hypertension diagnoses increased significantly, yet a substantial proportion remained undiagnosed or undertreated.
Conclusions:
- Elevated BP is highly prevalent in military EDs among active duty personnel.
- A significant gap exists between elevated BP findings and formal hypertension diagnoses.
- ED visits presenting with elevated BP warrant outpatient follow-up for timely hypertension evaluation and ASCVD risk reduction.
Introduction:
Hypertension is a leading modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) resulting in a significant burden on public health. Although the relationship between elevated blood pressure (BP) and long-term ASCVD risk is well-established in older adults, data for younger populations, such as military service members and athletes, remain limited. To assess early detection of hypertension, this study describes the prevalence of elevated BP in emergency departments (EDs) and its relationship with subsequent diagnoses of hypertension.
Materials And Methods:
A retrospective analysis was conducted using out-patient medical encounters involving active duty U.S. Armed Forces service members between January 2016 and December 2022 (N = 58,426). Sociodemographic and occupational data were obtained from administrative records and electronic health records provided medical data. Multivariable mixed-effects regression analysis was used to assess the relationship between patient characteristics and BP.
Results:
The prevalence of hypertension for our sample population presenting to military EDs was 37.9%, though only 3.4% had a prior diagnosis of hypertension. At the time of the ED visit, 30.2% of patients met the criteria for Stage 1 hypertension. During follow-up over the next 12 months, 41.7% remained at Stage 1 or Stage 2 hypertension, with the diagnosis of hypertension rising from 2.5% to 5.7%. Additionally, 7.7% of patients met the criteria for Stage 2 hypertension at the time of the ED visit. In follow-up, 68.7% remained at Stage 1 or 2 hypertension, while the diagnosis of hypertension increased from 8.2% to 16.7%.
Conclusion:
Elevated BP in military EDs is prevalent among active duty service members and is associated with an increased likelihood of future hypertension readings; however, the diagnosis of hypertension is lower than expected. These findings suggest that elevated BP in EDs should prompt outpatient follow-up for hypertension evaluation, facilitating early intervention and reducing long-term ASCVD risk.
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