THE VALUE OF EMERGENCY DEPARTMENT BLOOD PRESSURE MEASUREMENT FOR THE SCREENING OF HYPERTENSION. PAIN IS A SIGNIFICANT FACTOR? SEEMS NOT

Abstract

Objective: The value of emergency department (ED) blood pressure measurement for the screening of hypertension remains unclear. A systematic review was conducted to assess the performance of a screening strategy in adults using blood pressure (BP) measurement at the time of an ED consultation. The link between pain and high blood pressure is also described. Design and method: A systematic literature search on Embase, CINHAL and Medline was carried out. This systematic review was conducted in accordance with the PRISMA-Diagnostic Test Accuracy. Intervention studies with adults including at least one BP measurement for all participants were included. A repeat blood pressure assessment had to have been carried out to assess the validity of the elevated BP value within the next few days after the ED initial visit. Results: After review of 1,030 articles published between 1985 and 2018, 10 articles met the inclusion criteria. Mean age of participants was 51.6 years. A single study reports that BP screening was measured according to all the recommendations within the HTN guidelines referred to in the study. Half of the patients (50.2%) with elevated BP during the ED visit had BP corresponding to uncontrolled elevated blood pressure at follow-up measurement. Data about pain and blood pressure is reported in six of the included studies. None of these found a significant relationship between the concomitant presence of pain and an elevated BP measurement, and the fact of having an elevated or normal BP in a subsequent measurement without the presence of pain. Conclusions: The value of the blood pressure measurement in the ED is far from useless because it allows recognizing a true hypertension in one in two adults presenting with elevated BP. Moreover, it would be a mistake to attribute to pain alone the fact of presenting with an elevated OBPM in ED. Such patients could just as well be hypertensive when an ambulatory measurement is performed later without the presence of pain.