Date of Award
Open Access Thesis
Medical Doctor (MD)
OBJECTIVES: According to a WHO estimate, 1 in every 8 deaths worldwide is due to high blood pressure (BP). The Emergency Department (ED) provides an opportunity to identify individuals with undiagnosed hypertension (HTN) and refer them for BP recheck. The study objectives were to quantify the population in need referral for BP recheck and to determine the frequency of referral from the ED. METHODS: A retrospective, structured chart review of all patients > 18 years old seen in an urban adult ED over 5 days, excluding major trauma and pregnant pts. Patients with any systolic BP (SBP) > 140 or diastolic BP (DBP) > 90 had the following collected: demographics, all BPs, history of HTN, use of BP medication, and disposition. Patients with elevated BP, no prior diagnosis of HTN or BP medication use, and who were discharged met criteria for referral. For pts in need of referral, HTN-specific discharge instructions or physician plans were noted. RESULTS: Of 967 pts who met inclusion criteria, 339 (35.1%; 95% CI: 35-46%) had at least one elevated BP, with a mean maximum BP of 152.4/89.7. 45.4% were male and the mean age was 52.3. 130 pts, or 13.4% (95% CI: 11-16%) had severe elevation (JNC-7 stage 2 level): SBP > 160 or DBP > 100. 85.4% would have been identified as having elevated BP by initial measurement. 137 pts (14.1%; 95% CI: 12-16%) required referral for a repeat BP measurement, and 39 (4.0% of all included pts) had a SBP > 160 or DBP > 100. Of the 137 pts in need of referral, 2 pts (1.5%, 95% CI: 0-3.5%) received computer-generated discharge instructions, and 3 (2.2%, 95% CI: 0-3.9%) had a documented plan for referral. No significant correlation existed between need for referral and age, sex, or maximum or triage BP. CONCLUSIONS: 1 in 7 pts discharged from the adult ED has elevated BP with no prior diagnosis of HTN and should be referred for BP recheck. Few of these pts were identified as needing referral or received appropriate discharge instructions. 85% of pts in need of referral would have been identified by initial BP, which suggests that a screening and referral protocol could be initiated at triage.
Nerlinger, Andrew, "The Prevalence of Undiagnosed Hypertension in Ambulatory Emergency Department Patients and Lack of Adequate Referral" (2006). Yale Medicine Thesis Digital Library. 275.