Recognition of asymptomatic hypertension in an urban emergency department where are we now?

Kimberly Souffront, Christina Gestal, Gail D'Eramo Melkus, Lynne Richardson

Research output: Contribution to journalArticle

Abstract

Persistently elevated blood pressure ([BP]; hypertension [HTN]) occurs at higher rates in the emergency department ([ED]; 44%) than in the general population (27%) and disproportionately affects black patients and older adults. The American College of Emergency Physicians recommends referral to primary care for HTN confirmation and management when patients are asymptomatic and their BP is persistently elevated (W. Decker, S. Godwin, E. Hess, C. Lenamond, &A. Jagoda, 2006). However, adherence to this clinical policy is suboptimal. The purpose of this study was to examine the prevalence of asymptomatic HTN, rates of BP reassessment and referral, and factors associated with it among adult patients who visit the ED and who were discharged a decade after this policy was disseminated. A retrospective chart analysis of adults with an initial BP of 140/90 mmHg or greater and who were discharged was included in the sampling frame. Appropriate bivariate analysis, followed by multivariate regression, was conducted. There were 2,367 patients who met inclusion criteria, of which 1,184 patients had asymptomatic HTN. A greater proportion of the sample was male (51.3%), Black (43.2%; p < 0.000), middle aged (μ = 50.2 ± 16), and covered by Medicaid (39.8%). Mean initial BP was 170/88 mmHg. A large proportion of patients with asymptomatic HTN (94.2%) had no previously diagnosed cardiovascular disease (CVD). The BP reassessment rate was 49% (μ = 158/88), and these patients were more likely to have no previously diagnosed CVDs (p = 0.02). Only 4.6% (n = 28) of patients with asymptomatic HTN were referred, and these patients were more likely to have no previously diagnosed CVDs (p = 0.000) and be middle-aged (p = 0.008). Adherence to follow-up was 100%.

Original languageEnglish (US)
Pages (from-to)320-326
Number of pages7
JournalAdvanced Emergency Nursing Journal
Volume38
Issue number4
DOIs
StatePublished - Nov 13 2016

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Hospital Emergency Service
Hypertension
Blood Pressure
Referral and Consultation
Medicaid
Primary Health Care
Cardiovascular Diseases
Multivariate Analysis
Population

Keywords

  • Emergency department
  • Hypertension
  • Referral

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Recognition of asymptomatic hypertension in an urban emergency department where are we now? / Souffront, Kimberly; Gestal, Christina; D'Eramo Melkus, Gail; Richardson, Lynne.

In: Advanced Emergency Nursing Journal, Vol. 38, No. 4, 13.11.2016, p. 320-326.

Research output: Contribution to journalArticle

Souffront, Kimberly ; Gestal, Christina ; D'Eramo Melkus, Gail ; Richardson, Lynne. / Recognition of asymptomatic hypertension in an urban emergency department where are we now?. In: Advanced Emergency Nursing Journal. 2016 ; Vol. 38, No. 4. pp. 320-326.
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abstract = "Persistently elevated blood pressure ([BP]; hypertension [HTN]) occurs at higher rates in the emergency department ([ED]; 44{\%}) than in the general population (27{\%}) and disproportionately affects black patients and older adults. The American College of Emergency Physicians recommends referral to primary care for HTN confirmation and management when patients are asymptomatic and their BP is persistently elevated (W. Decker, S. Godwin, E. Hess, C. Lenamond, &A. Jagoda, 2006). However, adherence to this clinical policy is suboptimal. The purpose of this study was to examine the prevalence of asymptomatic HTN, rates of BP reassessment and referral, and factors associated with it among adult patients who visit the ED and who were discharged a decade after this policy was disseminated. A retrospective chart analysis of adults with an initial BP of 140/90 mmHg or greater and who were discharged was included in the sampling frame. Appropriate bivariate analysis, followed by multivariate regression, was conducted. There were 2,367 patients who met inclusion criteria, of which 1,184 patients had asymptomatic HTN. A greater proportion of the sample was male (51.3{\%}), Black (43.2{\%}; p < 0.000), middle aged (μ = 50.2 ± 16), and covered by Medicaid (39.8{\%}). Mean initial BP was 170/88 mmHg. A large proportion of patients with asymptomatic HTN (94.2{\%}) had no previously diagnosed cardiovascular disease (CVD). The BP reassessment rate was 49{\%} (μ = 158/88), and these patients were more likely to have no previously diagnosed CVDs (p = 0.02). Only 4.6{\%} (n = 28) of patients with asymptomatic HTN were referred, and these patients were more likely to have no previously diagnosed CVDs (p = 0.000) and be middle-aged (p = 0.008). Adherence to follow-up was 100{\%}.",
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