Undetected Hypertension in the Emergency Department

我们的建议旨在通过使用急诊科（ED）访问作为HTN筛查和医疗转诊的新机会来提高高血压（HTN）的检测。在美国，估计有6 500万人患有HTN；31%的人不知道自己的病情。早期发现可以导致更早开始治疗和预防心脏病发作，中风和肾衰竭。2002年，美国急诊科病人的访问量估计为1.1亿。即使在2001年，CDC估计这些患者中有1/3的初始血压大于140/90，常规转诊也很少进行。血压升高在急诊科中的意义尚不清楚，急诊科临床医生的重新评估和转诊实践很差。通常，ED中血压升高是由于疼痛或焦虑，尽管没有数据支持这一观点。考虑到美国每天在急诊科看到的大量患者，以及大量未被发现的HTN患者，急诊科是筛查未被发现的HTN的合理且潜在的重要地点。我们目标1)确定ED患者的比例没有HTN历史的两个或两个以上的血压读数大than140/90 ED访问期间,谁证明持续BP海拔测量在家的时候,在接下来的一个星期,和2)识别socio-demographic和临床特征(如HTN家族史、疼痛、焦虑、身体质量指数)与持续血压高程测量在家的时候,一周后访问。目标2本质上是探索性的。这项初步研究的数据将用于帮助识别潜在重要的患者特征，并帮助指导未来研究的功效分析，这些研究将以足够的样本量充分探索这一目标。我们将在ED中招收180名符合研究标准的受试者。在患者入组过程中，在急诊科就诊期间符合研究标准的患者（两个或两个以上ED血压大于140/90且无HTN病史）将被确定并入组。患者将在急诊科访问结束时参加简短的医学访谈，并给予家庭血压监测仪记录他们的血压，每天两次，持续一周。监视器还自动存储多达30个读数。一周后，患者将被要求归还家庭血压监测仪。监测返回后，研究人员将计算平均收缩压和舒张压（使用存储的读数），并准备一份总结报告，其中包括后续随访的建议，并将其邮寄给患者。在重新使用之前，所有的BP读数将从监视器上清除。该项目将为ED血压升高的意义提供证据，并对ED环境中未被发现的HTN的真实患病率有很好的了解。该项目还将开始探索未被发现的HTN的预测因素，以及ED bp升高与焦虑和疼痛之间的真正联系。这一目标将在今后的工作中得到充分的探讨。

Our proposal aims to improve the detection of hypertension (HTN) by using the emergency department (ED) visit as a novel opportunity for HTN screening and healthcare referral. In the United States (US), 65 million persons are estimated to have HTN; 31 percent are unaware of their condition. Early detection can lead to earlier initiation of therapy and prevention of heart attack, stroke and renal failure. In 2002, US ED patient visits were estimated at 110 million. Even though in 2001, the CDC estimated 1/3 of these patients had an initial BP greater than 140/90, routine referral is rarely done. The meaning of elevated BPs in the ED is unclear and reassessment and referral practices of ED clinicians are poor. Frequently, elevated BPs in the ED are attributed to pain or anxiety, although no data support this belief. Given the large number of patients seen in EDs daily across the US, and the large number of patients with undetected HTN, the ED is a logical and potentially important site to screen for undetected HTN. We aim 1) to determine the proportion of ED patients with no history of HTN and two or more blood pressure readings greater than140/90 during an ED visit, who demonstrate sustained BP elevations when measured at home during the following week, and 2) to identify the socio-demographic and clinical characteristics (e.g., family history of HTN, pain, anxiety, body mass index) associated with sustained blood pressure elevation when measured at home during the week following the ED visit. Aim 2 is exploratory in nature. Data from this pilot study will be used to help identify potentially important patient characteristics and help guide the power analysis for future research that will adequately explore this aim with a sufficient sample size. We will prospectively enroll 180 subjects in the ED that meet study criteria. During patient enrollment, patients meeting study criteria (two or more ED BPs greater than140/90 and no past medical history of HTN) during an ED visit will be identified and enrolled. Patients will participate in a brief medical interview conducted near the conclusion of their ED visit and be given a home BP monitor to record their BP twice a day for one week. The monitor also automatically stores up to 30 readings. At the end of one week patients will be asked to return the home BP monitor. Upon monitor return, study staff will calculate a mean SBP and DBP (using the stored readings) and prepare a summary report with recommendations for follow-up that will be mailed to the patient. All BP readings will be cleared from the monitor prior to re-use. This project will provide evidence of the meaning of elevated ED BPs and an excellent understanding of the true prevalence of undetected HTN in an ED setting. The project will also begin to explore predictors of undetected HTN and the true association between elevated ED BPs and anxiety and pain. This aim will be fully explored in future work.