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Hypertension in the emergency department may signal undiagnosed hypertension, not just pain or anxiety

A third of adults in the United States who have hypertension (high blood pressure) are unaware that they have the condition. Emergency department (ED) clinicians may be able to diagnose hypertension among these unsuspecting patients, suggests a new study.

Blood pressure readings taken during ED visits are thought to be over-representative of the patient's true blood pressure because of anxiety or pain experienced during the visit. However, a study by Paula Tanabe, Ph.D., M.P.H., and colleagues at Northwestern University's Feinberg School of Medicine in Chicago, found that only 6 percent of patients who had hypertension during their ED visit had normal blood pressure during the week after they returned home. Patients seen at an urban ED who had no history of hypertension but had two blood pressure measurements of at least 140/90 mm Hg (stage I hypertension) during their ED visit, were interviewed about their levels of anxiety and pain during the ED visit. Patients who were eligible to be discharged to home were asked to take their blood pressure twice a day with home blood pressure monitors and return the monitors to the researchers after 1 week.

Of the 156 patients who returned the monitors and completed the study protocol, 51 percent had elevated home blood pressure. Of patients with stage I hypertension in the ED, 52 percent had prehypertension (120-139/80-89 mm Hg), 36 percent had stage I hypertension, and 6 percent had home blood pressures meeting stage II hypertension (greater than 160 mm Hg systolic or greater than 100 mm Hg diastolic). The difference between ED and home systolic blood pressures was not associated with anxiety in the ED and was only slightly associated with pain (in the opposite direction than expected) during the ED visit.

The researchers suggest that brief patient education in the ED about hypertension and referral for a fuller assessment for possible hypertension is warranted in patients found to have two increased blood pressure readings during the ED visit. They recommend future research to develop systematic procedures to screen ED patients for hypertension and brief interventions recommending and providing referrals for blood pressure follow-up. The study was funded by the Agency for Healthcare Research and Quality (HS15619).

See "Increased blood pressure in the emergency department: Pain, anxiety, or undiagnosed hypertension?" by Dr. Tanabe, Stephen D. Persell, M.D., M.P.H., James G. Adams, M.D., and others in the March 2008 issue of Annals of Emergency Medicine 51(3), pp. 221-229.

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