Public Health, Hypertension, and the Emergency Department

Abstract

Hypertension (HTN) is the most common cardiovascular disease worldwide and is associated with severe long-term morbidity when not treated appropriately. Despite this, blood pressure (BP) control remains suboptimal, particularly among underserved populations and those who rely on emergency departments (EDs) as a source of primary care. ED providers encounter patients with severely elevated BP daily, and yet adherence to minimal standards of BP reassessment and referral to outpatient medical care, as recommended by the American College of Emergency Physicians, is limited. Barriers such as provider knowledge deficits, resource constraints, and negative attitudes towards patients who utilize EDs for nonurgent complaints are compounded by perceptions of HTN as a condition that can only be addressed in a primary care setting to contribute to this. Efforts to reduce this gap must go beyond government mandates to address systemic issues including access to care and payment models to encourage health promotion. Additionally, individual physician behavior can be shifted through targeted education, financial incentives, and the accumulation of high-quality evidence to encourage more proactive approaches to the management of uncontrolled HTN in the ED.

A Detroit Student-Run Free Clinic’s Management of Select Chronic Diseases

“…These encouraging findings support the notion that a student-run free clinic like Cass Clinic provides meaningful value for patients locally and serves as a community resource for managing BP, DM, and obesity. Literature exists on the importance of creating continuity of care for managing chronic disease states like HTN, especially the need for improved collaboration on the transition of care from emergency departments (ED) to primary care providers [ 22 ].…”

Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial

“…Because the ED has been perceived as a potentially suboptimal environment in which to conduct behavioral interventions, combined with resistance to management of chronic conditions in the ED setting, we also assessed the feasibility of the intervention bundle in various ways. 5 , 6 , 38 We evaluated time spent by RAs on study procedures with the patient in the ED (consent, data collection, and delivery of intervention). In addition, we examined text message engagement among participants randomized to the VERB intervention after text messages were adapted to include requests for confirmation.…”

“… 3 Elevated blood pressure (BP) is common among patients seeking care in the emergency department (ED), and ED visits related to hypertension increased by 25% between 2006 and 2012. 4 Current guidelines recommend clinicians inform patients with elevated ED BP about related risks and discuss lifestyle changes as well as follow‐up, 5 , 6 , 7 though implementation varies. 8 …”

Association between blood pressure, race, ethnicity and likelihood of admission to the hospital from United States emergency departments – A cross sectional study

“…Despite known recommendations to repeat blood pressure values above 140/90 and refer to outpatient facilities for follow up care 4 , the protocol for when to admit patients presenting to the ED with high systolic blood pressure is currently undefined. Nevertheless, patients with significantly raised SBPs are routinely admitted into the hospital for administration of antihypertensive drugs and monitoring.…”