HIGH BLOOD PRESSURE IN THE EMERGENCY DEPARTMENT. A TOOL FOR DETECTION OF HYPERTENSION? A FOLLOW-UP STUDY OF UNSELECTED PATIENTS ATTENDING AN EMERGENCY DEPARTMENT

Abstract

Objective: Hypertension is the most preventable cause of morbidity and mortality, but many individuals are not diagnosed and lack treatment control. High blood pressure (BP) in the emergency department (ED) is commonly observed but mostly used for short-term evaluation. We aimed to study the usefulness of high BP in the ED as a screening tool for undiagnosed hypertension. Design and method: We used the electronic medical record system to identify all patients that had attended the ED at a university hospital from 2018–01–01 to 2018–03–31 and from 2018-07-01 to 2018-09-30 with an obtained BP > = 160/100 mm Hg measured in the ED. We excluded patients with previously diagnosed hypertension and patients on any BP-lowering medication. All patients identified where contacted two years after attending the ED, by mail with a letter of consent and a questionnaire with the following question: 1. Have you measured your BP after your visit to the ED? 2. Have you been diagnosed with hypertension? 3. If yes – what kind of BP-medication has been prescribed? Results: 5424 patients attended the ED during the 6-months-period. 2625 patients were excluded due to a BP < 160/100 mm Hg, 1365 patients were excluded because of present BP-lowering medication, 523 patients were excluded because no BP was recorded, and 638 patients were deceased. A total of 271 patients were identified as suitable for the study and asked to participate. 167 individuals (62%) agreed to participate in the study and responded the questionnaire. Mean age of participants were 63,8 years and 50,2% were women. 135 patients (81%) had measured their BP after the ED-visit (question 1), and 48 (36%) of those had been diagnosed with hypertension (question 2). 96% of patients diagnosed with hypertension were on BP-lowering medication and 28% were on 2 or more different BP-lowering agents. Conclusions: To follow-up BP > = 160/100 mm Hg after an ED-visit can reveal undiagnosed hypertension in one third of the patients. Given the amount of undiagnosed hypertension, an ED-measured BP might provide an important tool with potential to detect and start treatment of hypertension.