Characteristics and referral of emergency department patients with elevated blood pressure
Characteristics and referral of emergency department patients with elevated blood pressure
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DOI：
10.1197/j.aem.2007.05.008
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发表时间：
2007-09-01
影响因子：
4.4
通讯作者：
Boudreaux, Edwin D.
中科院分区：
文献类型：
--
作者：
Baumann, Brigitte M.;Abate, Nicole L.;Boudreaux, Edwin D.
目的：评估急诊科高血压(BP)患者的患病率、特点和转诊情况，并将那些没有高血压病史(HTN)的患者与控制不佳的已知高血压患者进行比较。方法：对分诊收缩压(SBP)=140或舒张压(DBP)=90 mm Hg的非危重成年人进行前瞻性观察性研究。结果：在1719名未怀孕的成年人中，991人同意参与，其中455人的分诊血压值升高。使用三次测量的平均值，305人(67%)的SBP=140或DBP=90 mm Hg(平均SBP=157，平均DBP=89 mm Hg)。无HTN既往病史的受试者(n=105)主要是男性，更年轻，比已知的高血压患者(n=200)更有可能吸烟和饮酒。四分之三的受试者可以获得初级卫生保健，然而，在没有既往病史的受试者中，自上次BP评估以来的时间更长(155对53天，p=0.03)。这些受试者也不太可能被告知他们的血压升高(33%比50%，p=0.02)，也不太可能被ED工作人员指示进行重复测量(13%比31%，p=0.001)。结论：在血压升高的ED患者中，三分之一的人没有既往病史，其余的是控制不佳的高血压患者。两组都没有充分了解他们升高的血压，而既往没有HTN病史的组，也就是可能获得最大健康益处的人群，转诊率最低。
Objectives: To assess the prevalence, characteristics, and referral to health care of emergency department (ED) patients with elevated blood pressure (BP) and to compare those without a history of hypertension (HTN) with suboptimally controlled, known-hypertensive patients.Methods: A prospective, observational study was conducted in non-critically ill adults with a triage systolic blood pressure (sBP) of >= 140 or with a diastolic blood pressure (dBP) of >= 90 mmHg. Two additional measurements were obtained, and a standardized questionnaire recorded demographics, medical history, and ED staff referrals.Results: Of 1,719 nonpregnant adults, 991 agreed to participate, of whom 455 had elevated triage BP values. Using the mean of three measurements, 305 (67%) had an sBP of >= 140 or a dBP of >= 90 mm Hg (mean sBP = 157 and mean dBP = 89 mm Hg). Subjects with no prior history of HTN (n = 105) were predominantly male, younger, and more likely to smoke and consume alcohol than were known-hypertensive patients (n = 200). Three quarters of all subjects had access to primary health care, however, time elapsed since the last BP assessment was greater (155 vs. 53 d, p = 0.03) in subjects with no previous history. These subjects were also less likely to be informed of their elevated BP (33% vs. 50%, p = 0.02) or to be instructed by ED staff to obtain a repeat measurement (13% vs. 31 %, p = 0.001).Conclusions: Of ED patients with elevated BP, one third had no prior history, and the remainder were suboptimally controlled hypertensive patients. Both groups were inadequately informed of their elevated BPs, and the group with no prior history of HTN, the population likely to obtain the greatest health benefit, had the lowest referral rate.