Undiagnosed high blood pressure commonly found in emergency room patients
Unrecognized and poorly controlled hypertension is common among emergency room patients, especially African Americans, according to a Temple study in the September issue of Academic Emergency Medicine. African Americans have a higher risk of death and disability from cardiovascular diseases than any other population group, the researchers found.
Half of the study participants with high blood pressure reported that they were not under medical care for the condition. Further, a majority of this group stated that they had never been told that they had high blood pressure.
The study, “Elevated Blood Pressure in Urban Emergency Department Patients,” led by David Karras, professor of emergency medicine at the School of Medicine, was conducted at academic emergency departments in Philadelphia, New York, Atlanta and Miami. All participating sites are located in inner-city areas, largely serve economically disadvantaged patients, and are primary teaching hospitals of medical schools.
It’s part of an ongoing, multi-center investigation of what Karras calls a “monstrous issue”: how to handle elevated blood pressure in the ER. While hypertension has been thoroughly studied in the general population, there has been surprisingly little study of patients who come to the emergency room with hypertension.
“The emergency room offers a good opportunity to identify such patients and refer them for further evaluation and treatment,” Karras said, “but experts disagree on the best way to evaluate and manage hypertension in the ER.” Some experts advise a full battery of tests to rule out hypertension-related organ damage, a course that doesn’t necessarily lend itself to the fast-paced, urgent atmosphere of the ER.
“Some emergency doctors feel passionately that we’re obligated to provide comprehensive care because we are often the only health care some people get, particularly those who are economically disadvantaged,” Karras said. “Others believe that we are not primary-care physicians and we owe it to all of the patients in the emergency room to provide efficient, but not comprehensive, care.”
Karras recently completed a companion study on how high blood pressure is treated in the ER at the same four urban academic medical centers. He found that despite expert recommendations to conduct a full battery of tests, a majority of patients with hypertension in academic emergency rooms do not undergo such evaluation, are not given blood pressure medication and are not advised on how to manage their blood pressure after they’re released.
His research is now focused on developing better guidelines for the evaluation and management of hypertension in the ER.
One-fourth of adults in the United States, or 50 million people, suffer from hypertension, a major risk factor for heart attack, stroke and kidney disease. The key to reducing the risk is early diagnosis and long-term management, which often entails lifestyle changes and blood pressure lowering medication.
Of the patients visiting the ER during the study period, 20 percent, or 1400, had elevated blood pressure, which is above 140/90. Thirty percent of this group had severely elevated blood pressure, above 180/110.
And while many experts assume that the ER experience itself increases blood pressure, for one-third of study participants and half of those with severely elevated blood pressure, the hyertension remained weeks after the ER visit.
- By Eryn Jelesiewicz