Asymptomatically Elevated Blood Pressure in the Emergency Department: A Finding Deserving of Attention by Emergency Physicians?

Abstract

The Emergency Department (ED) may be an ideal place to screen and refer patients for blood pressure monitoring in the outpatient setting. Yet, little is known about the public health significance of asymptomatically elevated blood pressure measurements in the ED and what to tell patients when these abnormal vital signs are recorded. Since the prevalence of hypertension and inadequately treated hypertension is so high, the incidental finding of elevated blood pressure in a previously undiagnosed patient may be a pivotal moment in that patient's life. For those patients carrying the diagnosis of hypertension, it is the author's opinion that the observation of elevated blood pressures should trigger advice to see their physicians to consider medication adjustments or changes. Emergency Physicians and their staff are in a unique position to screen and refer large populations of patients to their community physicians and help abort the long-term sequelae of unidentified or inadequately managed hypertension. How best to advise physicians and their patients requires research and innovative methods for transmitting important information to patients that may be unrelated to their primary complaint in the ED. (Keio J Med 58 (1) :

Recognition of Asymptomatic Hypertension in an Urban Emergency Department

“…Patients with HTN are disproportionately represented in the ED (Lewin, 2007; Bauman, Abate, Cowan, Chansky, Rosa, Boudreaux, et al, 2007; Niska, 2011). Depending on the community in which the ED resides, many of these patients are without a usual source of care, (Niska, 2011; Bauman et al, 2007) are uninsured or on Medicaid (Niska, 2011; Karras, Ufberg, Heilpern, & Cienki, 2005); have a lower education level (Bauman et al, 2007; Karras et al, 2005; Niska, 2011); have an income less than $25,000 annually (Karras et al, 2005; Rhodes, Lauderdale, Stocking, Howes, Roizen, & Levinson, 2011); are a minority or immigrant (Bauman et al, 2007; Karras et al, 2005; Rhodes et al, 2001); or elderly (Bauman et al, 2007; Karras et al, 2005).…”