Diagnosis, Treatment, and Referral of Hypertension in an Emergency Department

Shah, Tushar; Aronow, Wilbert S.; Peterson, Stephen J.

doi:10.1111/j.1751-7141.2009.00034.x

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…The effect of acute hypertension on ICH has not been as well studied, despite a high proportion of emergency department (ED) patients presenting with hypertension – at least 25% have elevated blood pressure (over 140/90) and about 5% have severely elevated blood pressure (over 180/110). (4-8) Current guidelines recommend against the aggressive treatment of hypertensive ED patients without acute evidence of end-organ damage and instead recommend initiation of oral anti-hypertensives and outpatient follow-up. (9-11) In reality, however, these patients often receive inadequate follow-up care.…”

Section: Introductionmentioning

confidence: 99%

Risk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension

Navi

Parikh

Lerario

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Background Recent literature suggests that acute rises in blood pressure may precede intracerebral hemorrhage. We therefore hypothesized that patients discharged from the emergency department with hypertension face an increased risk of intracerebral hemorrhage in subsequent weeks. Methods Using administrative claims data from California, New York, and Florida, we identified all patients discharged from the Emergency Department from 2005 through 2011 with a primary diagnosis of hypertension (ICD-9-CM codes 401-405). We excluded patients if they were hospitalized from the emergency department or had prior histories of cerebrovascular disease at the index visit with hypertension. We used the Mantel-Haenszel estimator for matched data to compare each patient's odds of intracerebral hemorrhage during days 8-38 after emergency department discharge to the same patient's odds during days 373-403 after discharge. This cohort-crossover design with a one-week washout period enabled individual patients to serve as their own controls, thereby minimizing confounding bias. Results Among 552,569 patients discharged from the emergency department with a primary diagnosis of hypertension, 93 (0.017%) were diagnosed with intracerebral hemorrhage during days 8-38 after discharge compared to 70 (0.013%) during days 373-403 (odds ratio 1.33, 95% confidence interval 0.96-1.84). The odds of intracerebral hemorrhage were increased in certain subgroups of patients (≥60 years of age and those with secondary discharge diagnoses besides hypertension), but absolute risks were low in all subgroups. Conclusions Patients with emergency department discharges for hypertension do not face a substantially increased short-term risk of intracerebral hemorrhage after discharge.

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Section: Introductionmentioning

confidence: 99%

Risk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension

Navi

Parikh

Lerario

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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“…In March 2006, the American College of Emergency Physicians (ACEP) Clinical Policies Subcommittee recommended that patients with hypertension should be referred for follow‐up of hypertension and treatment 22 . We previously reported in a prospective study from the ED of a university medical center that 11 of 500 patients (2.2%) seen in the ED did not have their blood pressure (BP) measured 23 . Of the 489 patients who had their BP measured, 187 patients (38%) had hypertension diagnosed.…”

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confidence: 99%

“…Of the 489 patients who had their BP measured, 187 patients (38%) had hypertension diagnosed. Of the 187 patients with hypertension, 14 (8%) were treated for hypertension in the ED and 99 (53%) were referred to a physician or clinic for follow‐up of their hypertension 23 …”

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“…22 We previously reported in a prospective study from the ED of a university medical center that 11 of 500 patients (2.2%) seen in the ED did not have their blood pressure (BP) measured. 23 Of the 489 patients who had their BP measured, 187 patients (38%) had hypertension diagnosed. Of the 187 patients with hypertension, 14 (8%) were treated for hypertension in the ED and 99 (53%) were referred to a physician or clinic for follow-up of their hypertension.…”

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confidence: 99%

“…Of the 187 patients with hypertension, 14 (8%) were treated for hypertension in the ED and 99 (53%) were referred to a physician or clinic for follow-up of their hypertension. 23 These data were discussed with the medical director of the ED and with the medical staff of the ED. An educational program about the importance of diagnosing hypertension, treating it, and referring patients with hypertension for follow-up care was then given to the medical staff of the ED and a grand rounds on this topic given to the medical staff.…”

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Diagnosis, Treatment, and Referral of Hypertension or Prehypertension in an Emergency Department After an Educational Program: Preliminary Results

Shah

Aronow²,

Peterson

et al. 2011

The Journal of Clinical Hypertension

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The authors prospectively audited 602 randomly selected charts of patients seen in an academic emergency department (ED) for prevalence of hypertension and its management after an educational program (EP) because of results found in auditing 500 charts before the EP. Blood pressure was not measured in 11 of 500 patients (2.2%) before the EP and in 1 of 602 patients (0.2%) after the EP (P<.005). Hypertension was treated in the ED in 14 of 187 patients (8%) before the EP and in 29 of 282 patients (10%) after the EP (P=not significant). Of 187 patients with hypertension before the EP, 99 (53%) were referred to a physician or clinic for follow-up of hypertension, and 281 of 282 patients (99.6%) with hypertension were referred to a physician or clinic for follow-up of hypertension after the EP (P<.001). These data show that an EP administered to the staff of an academic ED significantly increased measurement of blood pressure in the ED, significantly increased obtaining a history of hypertension and of its treatment in ED patients, and significantly increased referral of patients with hypertension to a physician or clinic for follow-up of hypertension. J Clin Hypertens (Greenwich). 2011;13:413-415. Ó2011 Wiley Periodicals, Inc.Hypertension is a major risk factor for coronary events, 1-6 stroke, 1,2,6-9 congestive heart failure, 1,2,10,11and peripheral arterial disease. 12-16 Emergency department (ED) physicians have done a poor job in recognizing, treating, and referring patients with hypertension for follow-up care. [17][18][19][20][21] In addition, many patients being seen for medical care in the ED do not have a primary care physician or access to primary care.In March 2006, the American College of Emergency Physicians (ACEP) Clinical Policies Subcommittee recommended that patients with hypertension should be referred for follow-up of hypertension and treatment. 22 We previously reported in a prospective study from the ED of a university medical center that 11 of 500 patients (2.2%) seen in the ED did not have their blood pressure (BP) measured. 23 Of the 489 patients who had their BP measured, 187 patients (38%) had hypertension diagnosed. Of the 187 patients with hypertension, 14 (8%) were treated for hypertension in the ED and 99 (53%) were referred to a physician or clinic for follow-up of their hypertension. 23These data were discussed with the medical director of the ED and with the medical staff of the ED. An educational program about the importance of diagnosing hypertension, treating it, and referring patients with hypertension for follow-up care was then given to the medical staff of the ED and a grand rounds on this topic given to the medical staff. The medical staff was also taught to obtain follow-up BPs in the ED if the BP was elevated.After this educational program, a prospective study was then repeated during a 7-month period in 602 patients seen in the ED to determine whether the educational program had an effect on the prevalence of measuring BP, the prevalence of treatment of hypertension in the...

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Decrease in Smoking and Related Factor after the Price Raise of Tobacco in Hypertension Patients: Using 2015 Korea National Health and Nutrition Examination Survey

Joo¹,

Han²,

Park³

et al. 2019

J Health Info Stat

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The price of tobacco is an important factor affecting the smoking behavior. The Korean government raised the price of tobacco by 80% from 2,500 won to 4,500 won in 2015. This study investigated the change of smoking behavior after the price raise of tobacco in hypertension patients. Methods: The analysis used the data from the third year of the National Health and Nutrition Examination Survey (2015), which examined the changes in smoking habits after cigarette price hikes. Of the adults aged 19 years and older, 958 were currently smokers and 79 of the former smokers who quit smoking less than one year, excluding those who quit smoking before the cigarette price increase, total 1,037. In 193 hypertensive patients, 193 nonhypertensive patients were selected by 1:1 age group, and a total of 386 patients were analyzed. Data were analyzed using SAS 9.3 statistical program and chi-square and multiple logistic regression analysis. Results: The smoking reduction rate was 46.6% in the hypertensive group and 44.6% in the non-hypertensive group. There was no significant difference between the two groups (p = 0.683). Multivariate logistic regression analysis showed that factors affecting smoking cessation in hypertensive group were stress level, smoking prevention and smoking cessation education. In the hypertensive group, the odds ratio was 3.16 (95% CI, 1.39-7.18) in the normal range, If you receive less than the no-smoking education, the statistical significance is 4.17 (95% CI, 1.15-15.12). Conclusions: In the future, there will be a variety of measures such as the government's continuous cigarette price increase policy, active support for stress management in hypertensive patients, and the introduction of practical policies through socioeconomic approaches would be effective in reducing smoking rates in hypertensive patients.

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Diagnosis, Treatment, and Referral of Hypertension in an Emergency Department

Cited by 3 publications

References 23 publications

Risk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension

Risk of Intracerebral Hemorrhage after Emergency Department Discharges for Hypertension

Diagnosis, Treatment, and Referral of Hypertension or Prehypertension in an Emergency Department After an Educational Program: Preliminary Results

Decrease in Smoking and Related Factor after the Price Raise of Tobacco in Hypertension Patients: Using 2015 Korea National Health and Nutrition Examination Survey

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