Elevated blood pressure in the emergency department

Adhikari, Srikar; Mathiasen, Ross; Lander, Lina

doi:10.1097/mbp.0000000000000158

Cited by 12 publications

(4 citation statements)

References 11 publications

(13 reference statements)

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“…[11] Previous studies have repeatedly shown scarce levels of physician adherence to hypertension treatment guidelines in various situations. [12][13][14] In addition, there is a gap between primary healthcare physicians (PCPs) awareness of hypertension treatment guidelines and their actual practice. [15,16] A cross-sectional study by Lautenberg et al on 264 Dutch general practitioners found that most respondents had positive attitudes towards local hypertension practice guidelines, yet physicians perceived adherence to guidelines varied widely across recommendations.…”

Section: Introductionmentioning

confidence: 99%

Assessment of knowledge, attitude, and practice of primary healthcare physicians in Qatar towards hypertension management: An online cross-sectional study

Joudeh,

Elderawy,

Alhitmi

et al. 2023

Medicine

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Primary health care is integral to diagnosing and managing hypertension. This study aimed to assess the knowledge, attitude, practice, priority, and confidence of primary care physicians in Qatar toward hypertension diagnosis and management, and to measure the determinants of good knowledge, desirable attitudes, and desirable practices. We conducted a cross-sectional web-based survey using a modified version of the World Hypertension League Questionnaire during the period from August 30th to October 23rd, 2020. All primary care physicians working in any of Qatar’s 27 publicly run primary healthcare centers were invited to participate in the survey. Out of the 450 primary care physicians working at that time, 197 completed the study questionnaire with a response rate of 43.8%. Most respondents stated that they followed local or international treatment guidelines for hypertension management (96.4%). Primary care physicians were highly confident and prioritized hypertension management. The overall desirable practice score was 73.8%, with the highest score (95.4%) for assessing adherence to antihypertensive medications, whereas the lowest desirable practice score was 33.5% for counseling on home blood pressure monitoring. Fifty-one-point eight percentage and 62.4% correctly identified 140 mm Hg and 90 mm Hg as the systolic and diastolic blood pressure threshold for diagnosing hypertension in most patients. The lowest knowledge scores were for hypertension epidemiology in Qatar and recommended dietary modification for hypertensive patients. Respondents had positive attitudes toward task sharing with nonphysician healthcare workers for most items (58.9%–78.2%), except for drug prescriptions (30.5%). Primary care physicians in Qatar had positive attitudes, with high overall confidence and conviction (priority) scores toward hypertension. However, their knowledge scores and certain practices were suboptimal. Healthcare policymakers in Qatar should raise primary care physicians awareness of the current burden of untreated hypertension in the country by organizing targeted educational programs and emphasizing the importance of following national clinical practice guidelines in the diagnosis and management of hypertension.

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Section: Introductionmentioning

confidence: 99%

Assessment of knowledge, attitude, and practice of primary healthcare physicians in Qatar towards hypertension management: An online cross-sectional study

Joudeh,

Elderawy,

Alhitmi

et al. 2023

Medicine

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“…We only found one other study, a retrospective review of the quality of hypertension treatment in the emergency department, that simultaneously measured pain and BP. 19 Although they found no relationship between severity of pain and initial BP, 19 the study was limited to patients with elevated blood pressure and so is not directly comparable.…”

Section: Discussionmentioning

confidence: 97%

Association Between Pain, Blood Pressure, and Medication Intensification in Primary Care: an Observational Study

et al. 2020

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BACKGROUND: Treating hypertension is important but physicians often do not intensify blood pressure (BP) treatment in the setting of pain. OBJECTIVE: To identify whether reporting pain is associated with (1) elevated BP at the same visit, (2) medication intensification, and (3) elevated BP at the subsequent visit. DESIGN: Retrospective cohort SETTING: Integrated health system PARTICIPANTS: Adults seen in primary care EXPOSURE: Pain status based on numerical scale: mild (1-3), moderate (4-6), or severe (≥ 7). MAIN MEASURES: We defined elevated BP as ≥ 140/ 80 mmHg and medication intensification as increasing the dose or adding a new antihypertensive medication. Multilevel regression models were used to find the association between pain and ( 1) elevated BP at the index visit;(2) medication intensification at the index visit; and (3) elevated BP at the subsequent visit. Models adjusted for demographics, chronic conditions, and clustering within physician. In the third model, we adjusted for initial systolic BP as well. KEY RESULTS: Our population included 56,322 patients; 3155 (6%) reported mild pain, 5050 (9%) reported moderate pain, and 4647 (8%) reported severe pain at the index visit. Compared with no pain, the adjusted odds ratios of elevated BP were 1.38 (95% CI: 1.28-1.48) for severe pain, 1.06 (95% CI: 0.99-1.14) for moderate pain, and 1.02 (95% CI: 0.93-1.12) for mild pain. Adjusted odds ratios of medication intensification at the index visit were 0.65 (95% CI: 0.54-0.80) for mild pain, 0.61 (95% CI: 0.52-0.72) for moderate pain, and 0.55 (95% CI: 0.47-0.64) for severe pain. Among patients with elevated BP at the index visit, reporting pain at the index visit was not associated with elevated BP at the subsequent visit. CONCLUSIONS: When patients reported pain, physicians were less likely to intensify antihypertensive treatment; nevertheless, patients reporting pain were not more likely to have elevated BP at the subsequent visit.

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“…Adherence of doctors to clinical guidelines has been studied in various situations [15, 24, 25], however, their adherence to hypertension guidelines remain scarce. In Sudan, this is the first documented study that measures adherence of doctors to hypertension guidelines in line with the local and international guidelines.…”

Section: Introductionmentioning

confidence: 99%

Adherence of doctors to hypertension clinical guidelines in academy charity teaching hospital, Khartoum, Sudan

Abdelgadir

Elfadul

Hamid

et al. 2019

BMC Health Serv Res

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Background Clinical guidelines are systematically proven statements that help physicians to make healthcare decisions for specific medical conditions. Non-adherence to clinical guidelines is believed to contribute significantly to poor delivery of clinical care, and hence poor clinical outcomes. This study aimed at investigating adherence of doctors to hypertension clinical guidelines in Academy Charity Teaching Hospital, Khartoum, Sudan. Methods A cross-sectional hospital-based study was conducted during the period from January 2017 to October 2017 on a sample of 150 doctors. Adherence of doctors to hypertension guidelines was measured through the modified JNC7 adherence tool. Descriptive statistics was used to summarize the data (mean, standard deviation, median) and analyzed by frequency tables. Chi square test used to determine association among categorized variables. Logistic regression analysis was conducted to determine the relation between adherence to hypertension guidelines and the explanatory variables. All statistical tests were considered statistically significant when p value < 0.05. Results Of the 150 participants, 92% (138/150) were aware of the major hypertension treatment guidelines. 71% (98/138) reported the use of guidelines recommendations in their practice. Whereas 52% (78/150) were aware of local Sudanese guidelines. High adherence rate was highly statistically associated with job titles ( p = 0.000), and also associated with age of the participants ( p = 0.024) and duration of clinical experience ( p = 0.012). However, the logistic regression analysis revealed despite all those variables were contributing to adherence to the treatment guidelines, only duration of clinical experience was statistically significant ( p = 0.022). Conclusion The overall adherence of doctors to hypertension treatment guidelines was very low. This study highlights how a gap in clinical governance contributes to low adherence to clinical guidelines. Establishing regular clinical audit, issuing regulations to enforce the use of updated guidelines, along with introducing training programs in hospitals and continuous assessment to the practicing doctors are suggested as crucial interventions. Considerable efforts to build clinical governance in Sudan are required.

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Elevated blood pressure in the emergency department

Cited by 12 publications

References 11 publications

Assessment of knowledge, attitude, and practice of primary healthcare physicians in Qatar towards hypertension management: An online cross-sectional study

Assessment of knowledge, attitude, and practice of primary healthcare physicians in Qatar towards hypertension management: An online cross-sectional study

Association Between Pain, Blood Pressure, and Medication Intensification in Primary Care: an Observational Study

Adherence of doctors to hypertension clinical guidelines in academy charity teaching hospital, Khartoum, Sudan

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