Undetected Hypertension in the Emergency Department

我们的建议旨在通过使用急诊科（艾德）就诊作为高血压筛查和医疗转诊的新机会来改善高血压（HTN）的检测。在美国，估计有6500万人患有HTN; 31%的人不知道自己的病情。早期发现可以导致早期开始治疗和预防心脏病发作、中风和肾衰竭。2002年，美国艾德患者就诊人数估计为1.1亿。尽管在2001年，CDC估计这些患者中有1/3的初始BP大于140/90，但很少进行常规转诊。血压升高在艾德中的意义尚不清楚，艾德临床医生的重新评估和转诊实践也很差。通常，艾德的血压升高归因于疼痛或焦虑，尽管没有数据支持这一观点。考虑到美国每天在ED中看到的大量患者，以及大量未检出HTN的患者，艾德是筛查未检出HTN的合理且潜在重要的部位。我们的目标是：1）确定没有HTN病史且在艾德就诊期间两次或两次以上血压读数大于140/90的艾德患者的比例，这些患者在接下来的一周内在家中测量时表现出持续的血压升高; 2）确定社会人口统计学和临床特征（例如，HTN家族史、疼痛、焦虑、体重指数）与艾德访视后一周内在家中测量的持续血压升高相关。目标2是探索性的。这项试点研究的数据将用于帮助识别潜在的重要患者特征，并帮助指导未来研究的功效分析，以便在足够的样本量下充分探索这一目标。我们将在艾德前瞻性入组180例符合研究标准的受试者。在患者入组期间，将确定并入组在艾德访视期间符合研究标准（两个或多个艾德BP大于140/90且无HTN既往病史）的患者。患者将参加在其艾德访视结束时进行的简短医学访谈，并接受家庭血压监测仪，每天两次记录其血压，持续一周。监测仪还可自动存储多达30个读数。在一周结束时，患者将被要求返回家庭BP监测仪。监护仪返回后，研究工作人员将计算平均SBP和DBP（使用存储的读数），并准备一份总结报告，其中包含随访建议，并将其邮寄给患者。在重新使用之前，将从监护仪中清除所有BP读数。该项目将提供艾德血压升高的意义的证据，并对艾德环境中未检测到的HTN的真实患病率有很好的理解。该项目还将开始探索未检测到的HTN的预测因素以及艾德血压升高与焦虑和疼痛之间的真正联系。在今后的工作中将充分探讨这一目标。

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.