Screening for hypertension in the emergency department

Area of Science:

• Cardiology
• Public Health
• Healthcare Management

Background:

• Hypertension is a major risk factor for cardiovascular disease.
• Effective management of hypertension requires timely diagnosis and follow-up care.
• Emergency departments (EDs) are a potential setting for identifying patients with undiagnosed or uncontrolled hypertension.

Purpose of the Study:

• To evaluate the recognition of hypertension and initiation of follow-up care for patients with elevated blood pressure in emergency departments.
• To identify potential gaps in the management of hypertensive patients presenting to university-affiliated EDs.

Main Methods:

• Retrospective review of emergency department charts from three university-affiliated hospitals.
• Analysis of blood pressure (BP) readings and physician documentation.
• Assessment of referrals for hypertension follow-up care.

Main Results:

• Less than 50% of all patients with elevated BP recorded in ED charts were recognized as hypertensive by physicians.
• At the primary teaching hospital, less than 33% of patients with the greatest BP elevation (over 20 mm Hg above normal) were referred for hypertension follow-up.
• Significant underdiagnosis and undertreatment of hypertension were observed in the ED setting.

Conclusions:

• Physician recognition of hypertension in the ED setting is suboptimal.
• A substantial proportion of patients with significantly elevated BP do not receive timely follow-up care, highlighting a missed opportunity for cardiovascular risk reduction.
• Improved protocols and physician education are needed to enhance hypertension detection and management in emergency departments.