ER Visits Identify Undiagnosed High Blood Pressure

Most people go to the emergency room for treatment of urgent health problems, but new research suggests that many ER patients also have untreated high blood pressure, a major cause of chronic health problems.

Most people go to the emergency room for treatment of urgent health problems, but new research suggests that many ER patients also have untreated high blood pressure, a major cause of chronic health problems. High blood pressure in the emergency room should be taken seriously and may not necessarily be caused by ER-related stress, the study’s lead author told Reuters Health. The emergency room is “the only point of contact that many otherwise healthy people have with the healthcare system,” Dr. David J. Karras of Temple University School of Medicine in Philadelphia said in an interview. For people who do not see a doctor on a regular basis, the ER may be the only time that they have their blood pressure and other vital signs measured. The problem with blood pressure readings in the ER is that doctors have not quite known what to do with them, according to Karras. Because going to the emergency room is a stressful experience, doctors have wondered whether high blood pressure may be just a temporary, stress-related increase, and not really high blood pressure (hypertension). “The temptation is to say that it does not represent true hypertension,” Karras explained. “We’re in this quandary of not knowing whether to take this blood pressure reading seriously.” Karras and his colleagues have found that, for some seemingly healthy people, high blood pressure in the ER is not a temporary condition. So far, the study has included about 1,400 people with blood pressure readings of at least 140/90. This represents about 20 percent of all patients seen at four urban emergency departments that served mostly African American and Latino patients. Karras and his colleagues contacted half of these patients with high blood pressure a few weeks after they were treated in the ER. High blood pressure “wasn’t just a phenomenon of the ER,” Karras said. Since being treated in the ER, about one third of patients had been told by a primary care physician that they had high blood pressure. And of the patients with the most severe high blood pressure–a reading of at least 180/110–about half of them still had high blood pressure several weeks after being treated in the ER. The bottom line for people who have been told that they have high blood pressure is that “it’s extremely important to have that followed up,” Karras said. A high blood pressure reading in the ER “really does suggest that you’re likely to have hypertension.” While it is important for the public not to ignore high blood pressure readings, Karras pointed out that medical professionals still need to determine the best way to deal with high blood pressure in the ER. As the study continues, he said, “Our goal is to develop some guidelines for managing high blood pressure in the ER.” Karras plans to present the findings of the study in May at a meeting of the Society for Academic Emergency Medicine in Orlando. (Source: Reuters Health: Merritt McKinney: Medline Plus: March 2004)