Hypertension in the ED: still an unrecognized problem

Svenson, James E.; Repplinger, Michael D.

doi:10.1016/j.ajem.2007.11.024

Cited by 28 publications

(35 citation statements)

References 15 publications

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“…Several studies have documented a systematic underrecognition of pediatric hypertension, even when blood pressure is measured. [35][36][37] The high frequency (89%) of height measurement in patients whose blood pressure was measured suggests that screening could have occurred at most preventive visits. However, in at least 11% of preventive visits in which blood pressure was measured, blood pressure values could not have been interpreted appropriately.…”

Section: Discussionmentioning

confidence: 99%

Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000–2009

et al. 2012

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BACKGROUND AND OBJECTIVE: Hypertension occurs in 2% to 5% of children in the United States, and its prevalence has increased during the obesity epidemic. There is no consensus among professional organizations about how frequently blood pressure should be measured in children >3 years old. The purpose of this study was to estimate the frequency of hypertension screening during ambulatory pediatric visits in the United States and to determine patient- and provider-level factors associated with screening during visits specifically for preventive care. METHODS: We analyzed data from a nationally representative sample of ambulatory visits by using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 2000 through 2009. In the subset of visits involving patients aged 3 to 18 years, we estimated the frequency of screening during all visits, preventive visits, and preventive visits in which overweight/obesity was diagnosed. We used multivariable logistic regression to identify patient- and provider-level factors associated with screening. RESULTS: Hypertension screening occurred during 35% of ambulatory pediatric visits, 67% of preventive visits, and 84% of preventive visits in which overweight/obesity was diagnosed. Between 2000 and 2009, the frequency of screening increased in all visits and in preventive visits. Factors independently associated with screening included older age and overweight/obesity diagnosis. CONCLUSIONS: Providers do not measure blood pressure in two-thirds of pediatric visits and one-third of pediatric preventive visits. Providers may understand the importance of screening among overweight/obese children; however, efforts to encourage routine screening, particularly in young children, may be needed.

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Section: Discussionmentioning

confidence: 99%

Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000–2009

et al. 2012

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“…52 Such inertia probably has relevance to EPs, as the referral rate of hypertensive ED patients to specific follow-up has been consistently shown to be 10% or less. 13,15,16,47 While the EP's role in the care of the hypertensive patient is very different from that of a primary care physician, both appear to share as least one characteristic of clinical inertia: overestimation of the care provided to patients with the disease of interest. A recent multicenter assessment of ED practice patterns revealed that EPs overestimate the percentage of patients recognized and referred for HTN control by a factor 2-3 times that of their actual practice.…”

Section: Clinical Inertiamentioning

confidence: 99%

“…6,9,18,19,46 EPs, however, do a poor job of responding to asymptomatic HTN when it is identified and, unfortunately, efforts to improve provider performance have been largely ineffective. 11,15,16,[47][48][49] To better understand why this may be so and to facilitate improvements in the care of asymptomatic HTN in the ED, an appreciation of existing challenges is critical.…”

Section: Challenges To Effective Management Of Asymptomatic Htn In Thmentioning

confidence: 99%

“…Despite the recent release of a clinical policy by the American College of Emergency Physicians (ACEP), 9 many clinicians remain inattentive to the importance of appropriate intervention for patients with HTN. 6,13,15,16,18,19 Given the public health implications of poor BP control, [20][21][22][23] a systematic reformation in the way emergency physicians (EPs) approach management of this condition is warranted.…”

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confidence: 99%

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Asymptomatic Hypertension in the Emergency Department: A Matter of Critical Public Health Importance

Levy

Cline

2009

Academic Emergency Medicine

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Asymptomatic hypertension (HTN) is commonly encountered in the emergency department (ED), but in most circumstances little is done about it. While many factors may contribute to this, the failure to recognize asymptomatic HTN as a public health problem is particularly important. Given the established long-term consequences of elevated blood pressure (BP), a reconsideration of methods that could enhance surveillance and intervention in the ED is needed. In this article, we discuss the relevant epidemiology of asymptomatic HTN and present a novel approach using a modified version of the Haddon's matrix to systematically address the challenges that contribute to ineffective screening and suboptimal outcomes.

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“…Tais sinais são muito frequentes nos casos de dor aguda, inclusive no cotidiano da população, o que pode ter refletido de maneira positiva na prevalência de acertos na referida questão, uma vez que atualmente é muito discutida a correlação dos distúrbios dos sinais vitais, incluindo aumento da frequência cardíaca e da pressão arterial, frequentemente associadas ao sintoma dor (KING;BAIR, 2012;LEDOWSKI et al, 2012;SVENSON;REPPLINGER, 2008).…”

Section: A Implementação Da Webquest "Avaliação Da Dor"unclassified

O uso de ambientes virtuais de aprendizagem, como estratégia de ensino, por meio da metodologia Webquest em Cursos de Graduação em Enfermagem

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Hypertension in the ED: still an unrecognized problem

Cited by 28 publications

References 15 publications

Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000–2009

Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000–2009

Asymptomatic Hypertension in the Emergency Department: A Matter of Critical Public Health Importance

O uso de ambientes virtuais de aprendizagem, como estratégia de ensino, por meio da metodologia Webquest em Cursos de Graduação em Enfermagem

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