Characteristics and referral of emergency department patients with elevated blood pressure.
OBJECTIVE
To assess the prevalence, characteristics, and referral to health care of emergency department (ED) patients with elevated blood pressure (BP) and to compare those without a history of hypertension (HTN) with suboptimally controlled, known-hypertensive patients.


METHODS
A prospective, observational study was conducted in non-critically ill adults with a triage systolic blood pressure (sBP) of > or =140 or with a diastolic blood pressure (dBP) of > or =90 mmHg. Two additional measurements were obtained, and a standardized questionnaire recorded demographics, medical history, and ED staff referrals.


RESULTS
Of 1,719 nonpregnant adults, 991 agreed to participate, of whom 455 had elevated triage BP values. Using the mean of three measurements, 305 (67%) had an sBP of > or =140 or a dBP of > or =90 mm Hg (mean sBP = 157 and mean dBP = 89 mm Hg). Subjects with no prior history of HTN (n = 105) were predominantly male, younger, and more likely to smoke and consume alcohol than were known-hypertensive patients (n = 200). Three quarters of all subjects had access to primary health care; however, time elapsed since the last BP assessment was greater (155 vs. 53 d, p = 0.03) in subjects with no previous history. These subjects were also less likely to be informed of their elevated BP (33% vs. 50%, p = 0.02) or to be instructed by ED staff to obtain a repeat measurement (13% vs. 31%, p = 0.001).


CONCLUSIONS
Of ED patients with elevated BP, one third had no prior history, and the remainder were suboptimally controlled hypertensive patients. Both groups were inadequately informed of their elevated BPs, and the group with no prior history of HTN, the population likely to obtain the greatest health benefit, had the lowest referral rate.
Baumann
Brigitte M
BM
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, Camden, NJ, USA. baumann-b@cooperhealth.edu
Abate
Nicole L
NL
Cowan
Robert M
RM
Chansky
Michael E
ME
Rosa
Karena
K
Boudreaux
Edwin D
ED
D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*