Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension

Intergenerational Hypertension Prevention Education for Children and Family Members: A Longitudinal Assessment

INTRODUCTION

Many adults are unaware of hypertension risks. Fortunately, hypertension is preventable with lifestyle modifications and regular blood pressure (BP) monitoring. Through reverse socialization (RS), children, acting as information agents, can potentially influence adults' long-term health behaviours.

AIM

This study aimed to assess the longitudinal effects of a RS-based intervention, with and without experiential component of performing home BP measurement, in enhancing hypertension awareness and motivating regular BP measurement among children and their adult family members (AFMs).

METHODS

The intervention involves educating grade five children about hypertension and asking them to share this information with AFMs either using only information brochures (non-experiential intervention) or complemented with performing home BP measurement (experiential intervention). Hypertension knowledge and coping appraisals to perform regular BP measurement were assessed before, immediately post-program, and three-months post-program.

RESULTS

Children's (n = 514) BP knowledge and confidence in sharing BP knowledge improved post-intervention and sustained longitudinally, but the effect was more pronounced among those in the experiential intervention. AFMs' (n = 251) self-efficacy to perform regular BP measurement and intention to prevent hypertension improved only for those in the experiential intervention. Improvement was sustained for self-efficacy only. AFMs' response cost reduced long-term for both intervention types. However, AFMs' hypertension knowledge and response efficacy were unchanged.

CONCLUSIONS

Even one-off short RS-based interventions with children can be sufficient to increase hypertension awareness for AFMs. An experiential component in similar family-targeted RS programs can capitalize on improvements in self-efficacy and intention to effect sustained behaviour change in hypertension preventive behaviours.

Hypertension Management in Emergency Departments

BACKGROUND

Elevated blood pressure (BP) is pervasive among patients that visit emergency departments (EDs) for their care.

METHODS

In this review article, we outline the current approach to the management of these individuals and highlight the crucial role emergency medicine clinicians play in reducing the morbidity associated with elevated BP.

RESULTS

We highlight the critical importance of immediate treatment when elevated BP contributes to new or worsening end-organ injury but emphasize that such hypertensive emergencies are rare. For the vast majority of patients with elevated BP in the ED who do not have new or worsening end-organ injury from elevated BP, immediate BP reduction within the ED is not recommended or safe. Nonetheless, within weeks after an ED visit, there is a pressing need to improve the care of patients with elevated or previously undiagnosed hypertension. For many, it may be their only regular point of engagement with the healthcare system. To address this, we present novel perspectives that envision a new role for emergency medicine in chronic hypertension management-one that acknowledges the significant population-level gaps in BP control that contribute to disparities in cardiovascular disease and sets the stage for future changes in systems-based practice.

CONCLUSIONS

Emergency medicine plays a key and evolving role in reducing morbidity associated with elevated BP.

Hospital-based intervention to enhance hypertension diagnosis in Kalasin hospital, Thailand, 2017-2019: A pre-post pilot intervention study

In Thailand 5.9 million individuals ≥15 years old have undiagnosed hypertension. The intervention to reduce undiagnosed hypertension was piloted and aimed to compare pre- and post-intervention hypertension diagnosis rate and follow-up rate. A hospital-based pre- and post-intervention study was piloted in a general hospital in Thailand. The intervention included an electronic pop-up alert when raised blood pressure was observed and a follow-up protocol. The follow-up protocol entered patient information in a follow-up book that scheduled an appointment to recheck blood pressure. Statistical analyses compared the rate of hypertension diagnosis and follow-up between the pre- and post-intervention periods, adjusted for differences in baseline characteristics. A post-intervention, self-report survey among nurses and nurse-aids explored perceptions about raised blood pressure management and solicited suggestions to improve the intervention. 574 raised blood pressure patients visited the hospital in the pre-intervention period; 27.4% returned for follow--up; and hypertension diagnosis rate was 1.4%. Among 686 post-intervention raised blood pressure patients, overall hypertension diagnosis rate improved to 6.1%. In per-protocol patients, 81.9% were booked to follow--up, hypertension diagnosis rate was 18.6%, and the adjusted odds ratio of hypertension diagnosis was 4.5 times higher compared with the pre-intervention period. By self-report, 20% of health workers had no time to provide the follow-up book due to work overload, yet >57% reported that information technology improved detection of raised blood pressure and improved follow-up. The interventions significantly increased the hypertension diagnosis rate and follow-up among raised blood pressure patients in a single hospital but may benefit from incorporating an information technology-assisted follow-up protocol.

Association of Elevated Blood Pressure in the Emergency Department With Chronically Elevated Blood Pressure

Background Emergency department (ED) visits for hypertension are rising, but the importance of elevated blood pressure (BP) measured during the ED visit is controversial. We evaluated the relationship between ED BP and mean BP over the subsequent year. Methods and Results We performed a retrospective cohort study from January 1, 2010 to December 31, 2013 of 8105 adult patients who made 1 visit to an academic medical center ED with ≥2 ED BPs and ≥2 BPs measured in the subsequent year. The primary exposure was lowest ED systolic BP. The primary outcome was mean systolic BP ≥140 mm Hg over the year following the index ED visit. Diastolic BP was examined as a secondary exposure and outcome. Multiple logistic regression was performed adjusting for several covariates, with interaction terms for hypertension diagnosis, ED disposition, pain-related ED chief complaint, and sex. Patients whose lowest ED systolic BP was 140 to 159 mm Hg had an adjusted odds ratio of having a mean SBP ≥140 mm Hg in the subsequent year of 10.9 (95% CI, 7.6-15.6). Patients without diagnosed hypertension and ED BP 140/90 to 159/99 mm Hg were more likely to have elevated BP in the following year. Hospitalization increased the likelihood of persistently elevated systolic BP but not diastolic BP. There was no effect modification by pain-related ED complaint. Conclusions When ED BP is consistently elevated, BP is highly likely to remain elevated in the subsequent year, regardless of pain, and particularly among patients without diagnosed hypertension. Further research is needed to determine the optimal management of elevated ED BP.