title: Public Health, Hypertension, and the Emergency Department.
abstract: Hypertension (HTN) is the most common cardiovascular disease worldwide and is associated with severe long-term morbidity when not treated appropriately. Despite this, blood pressure (BP) control remains suboptimal, particularly among underserved populations and those who rely on emergency departments (EDs) as a source of primary care. ED providers encounter patients with severely elevated BP daily, and yet adherence to minimal standards of BP reassessment and referral to outpatient medical care, as recommended by the American College of Emergency Physicians, is limited. Barriers such as provider knowledge deficits, resource constraints, and negative attitudes towards patients who utilize EDs for nonurgent complaints are compounded by perceptions of HTN as a condition that can only be addressed in a primary care setting to contribute to this. Efforts to reduce this gap must go beyond government mandates to address systemic issues including access to care and payment models to encourage health promotion. Additionally, individual physician behavior can be shifted through targeted education, financial incentives, and the accumulation of high-quality evidence to encourage more proactive approaches to the management of uncontrolled HTN in the ED.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Wayne State University, 4201 St. Antoine, Detroit, MI, USA. abrody@med.wayne.edu.|Clinical Research Service Center, School of Medicine, Wayne State University, Detroit, MI, USA. abrody@med.wayne.edu.|Integrative Biosciences Center (iBio), Wayne State University, 6135 Woodward Ave., Detroit, MI, 48202, USA. abrody@med.wayne.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: Brody
authors.affiliation: Department of Emergency Medicine, School of Medicine, Wayne State University, 4201 St. Antoine, Detroit, MI, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Janke
authors.affiliation: Department of Emergency Medicine, School of Medicine, Wayne State University, 4201 St. Antoine, Detroit, MI, USA.
authors.forename: Vineet
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Emergency Medicine, School of Medicine, Wayne State University, 4201 St. Antoine, Detroit, MI, USA.|Clinical Research Service Center, School of Medicine, Wayne State University, Detroit, MI, USA.|Integrative Biosciences Center (iBio), Wayne State University, 6135 Woodward Ave., Detroit, MI, 48202, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Levy
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods / Q000592:standards / Q000639:trends; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy; D010342:Patient Acceptance of Health Care; D011634:Public Health / Q000379:methods / Q000639:trends
keywords: Cardiovascular disease; Emergency department; Health disparity; Hypertension; Hypertension and public health; Primary care in ER