Unrecognized hypertension is common among emergency room patients, especially African Americans

Unrecognized and poorly controlled hypertension is common among emergency room patients, especially African Americans, according to a Temple University study in the September issue of Academic Emergency Medicine. African Americans have a higher risk of death and disability from cardiovascular diseases than any other population group.

Half of the study participants with high blood pressure reported that they were not under medical care for the condition. Further, the majority of this group stated that they had never been told that they had high blood pressure.

The study, "Elevated Blood Pressure in Urban Emergency Department Patients," led by David Karras, M.D., professor of emergency medicine at Temple University School of Medicine, was conducted at academic emergency departments in Philadelphia, New York, Atlanta and Miami. All participating sites are located in inner-city areas, serve largely economically disadvantaged patients, and are primary teaching hospitals of medical schools. It's part of an on-going multi-center investigation of what Karras calls a monstrous issue: How to handle elevated blood pressure in the ER. While hypertension has been thoroughly studied in the general population, there has been surprisingly little study of patients who come to the emergency room with hypertension.

"The emergency room offers a good opportunity to identify such patients and refer them for further evaluation and treatment, said Karras, but experts disagree on the best way to evaluate and manage hypertension in the ER." Some experts advise a fully battery of tests to rule out hypertension-related organ damage, a course that doesn't necessarily lend itself to the fast-paced, urgent atmosphere of the ER.

"Some emergency doctors feel passionately that we're obligated to provide comprehensive care because we are often the only health care some people get, particularly those who are economically disadvantaged," said Karras. "Others believe that we are not primary care physicians and we owe it to all of the patients in the emergency room to provide efficient, but not comprehensive, care."

Karras recently completed a companion study on how high blood pressure is treated in the ER at the same four urban academic medical centers. He found that despite expert recommendations to conduct a full battery of tests, the majority of patients with hypertension in academic emergency rooms do not undergo such evaluation, are not given blood pressure medication, and are not advised on how to manage their blood pressure after discharge.

His research is now focused on developing better guidelines for the evaluation and management of hypertension in the ER.

One-quarter of adults in the U.S., or 50 million people, suffer from hypertension, a major risk factor for heart attack, stroke and kidney disease. The key to reducing the risk is early diagnosis and long-term management, which often entails lifestyle changes and blood pressure lowering medication.

Of the patients visiting the ER during the study period, 20 percent or 1400, had elevated blood pressure, which is above 140/90. Thirty percent of this group had severely elevated blood pressure, above 180 /110. And while many assume that the ER experience itself increases blood pressure, for one-third of study participants and half of those with severely elevated blood pressure, the hypertension remained weeks after the ER visit.


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