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Souffront K, P. Nelson B, Lukas M, Reyes Garay H, Gordon L, Matos T, Hanesworth I, Mantel R, Shubeck C, Bernstein C, T. Loo G, Richardson LD. Stage B Heart Failure Is Ubiquitous in Emergency Patients with Asymptomatic Hypertension. West J Emerg Med 2024; 25:160-165. [PMID: 38596912 PMCID: PMC11000548 DOI: 10.5811/westjem.17990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Hypertension is the leading risk factor for morbidity and mortality throughout the world and is pervasive in United States emergency departments (ED). This study documents the point prevalence of subclinical heart disease in emergency patients with asymptomatic hypertension. Method This was a prospective observational study of ED patients with asymptomatic hypertension conducted at two urban academic EDs that belong to an eight-hospital healthcare organization in New York. Adult (≥18 years of age) English- or Spanish-speaking patients who had an initial blood pressure (BP) ≥160/100 millimeters of mercury (mmHg) and second BP ≥140/90 mm Hg, and pending discharge, were invited to participate in the study. We excluded patients with congestive heart failure, renal insufficiency, and atrial fibrillation, or who were pregnant, a prisoner, cognitively unable to provide informed consent, or experiencing symptoms of hypertension. We assessed echocardiographic evidence of subclinical heart disease (left ventricular hypertrophy, and diastolic and systolic dysfunction). Results A total of 53 patients were included in the study; a majority were young (mean 49.5 years old, [SD 14-52]), self-identified as Black or Other (n = 39; 73.5%), and female (n = 30; 56.6%). Mean initial blood pressure was 172/100 mm Hg, and 24 patients (45.3%) self-reported a history of hypertension. Fifty patients completed an echocardiogram. All (100%) had evidence of subclinical heart disease, with 41 (77.4%) displaying left ventricular hypertrophy and 31 (58.5%) diastolic dysfunction. There was a significant relationship between diastolic dysfunction and female gender [x2 (1, n = 53) = 3.98; P = 0.046]; Black or other race [x2 (3, n = 53) = 9.138; P = 0.03] and Hispanic or other ethnicity [x2 (2, n = 53) = 8.03; P = 0.02]. Less than one third of patients demonstrated systolic dysfunction on echocardiogram, and this was more likely to occur in patients with diabetes mellitus [x2 (1, n = 51) = 4.84; P = 0.02]. Conclusion There is a high probability that Black, Hispanic, and female patients with asymptomatic hypertension are on the continuum for developing overt heart failure. Emergency clinicians should provide individualized care that considers their unique health needs, cultural backgrounds, and social determinants of health.
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Affiliation(s)
- Kimberly Souffront
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Center for Nursing Research and Innovation, Mount Sinai Health System, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
| | - Bret P. Nelson
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Megan Lukas
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | | | - Lauren Gordon
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
| | - Thalia Matos
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Isabella Hanesworth
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Rebecca Mantel
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Claire Shubeck
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Cassidy Bernstein
- Center for Nursing Research and Innovation, Mount Sinai Health System, New York
| | - George T. Loo
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
| | - Lynne D. Richardson
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
- Icahn School of Medicine at Mount Sinai, Department of Artificial Intelligence and Human Health, New York
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Chiu DT, Stenson BA, Nathanson LA, Sanchez LD. Use of an Automated Discharge Instruction Module to Improve Outpatient Follow-Up for Emergency Department Patients with Elevated Blood Pressure. High Blood Press Cardiovasc Prev 2022; 29:481-485. [PMID: 35840860 DOI: 10.1007/s40292-022-00533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION Hypertension is often incidentally discovered in the emergency department (ED); these patients may benefit from close follow-up. We developed a module to automatically include discharge instructions for patients with elevated blood pressure (BP) in the ED, aiming to improve 30-day follow-up. AIM This study sought to determine if automated discharge instructions for patients with elevated blood pressure in the ED improved 30-day follow-up with a patient's primary care physician (PCP). METHODS We developed an automated module with standardized instructions for patients with elevated BP. These were read upon discharge, and e-mailed to the PCP. We analyzed 193 patients during a 1-month interval after implementation, and 207 during 1-month the year prior. The groups were compared using Fisher's exact test. RESULTS Thirty-day follow-up was 52.2% pre-implementation and 48.4% post-implementation, with no significant difference noted. For patients without known hypertension, follow-up slightly improved, but not significantly. For hypertensive patients, follow-up rates significantly decreased post-implementation. CONCLUSIONS Despite implementation of automated discharge instructions, we found no improvement in 30-day follow-up. Patients without hypertension trended towards improved follow-up, possibly being more attentive to new abnormal BP readings. However, known hypertensive patients followed-up at a lower rate, which was unexpected and requires further investigation.
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Affiliation(s)
- David T Chiu
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bryan A Stenson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Larry A Nathanson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham & Women's Faulkner Hospital, Boston, MA, USA
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Hossain A, Ahsan GU, Hossain MZ, Hossain MA, Sultana ZZ, Arefin A, Jahan SMS, Sutradhar P. A prospective longitudinal study with treated hypertensive patients in Northern Bangladesh (PREDIcT-HTN) to understand uncontrolled hypertension and adverse clinical events: A protocol for 5-years follow-up. PLoS One 2022; 17:e0269240. [PMID: 35639707 PMCID: PMC9154182 DOI: 10.1371/journal.pone.0269240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Uncontrolled hypertension is the most common cause of major adverse clinical events (MACE), such as myocardial infarction, strokes, and death due to CVDs, in both developed and developing countries. Western-led studies found that treated hypertensive adults with uncontrolled hypertension were more at-risk of all-cause and CVD-specific mortality than normotensives. The PRospEctive longituDInal sTudy of Treated HyperTensive patients of Northern-Bangladesh (PREDIcT-HTN) study principally aims to estimate the incidence of MACE in treated hypertensive patients and identify the determinants of MACE. The secondary objective is to find the prevalence of uncontrolled hypertension in treated hypertensive patients and the associated risk factors.
Methods and analysis
The treated hypertensive patients were obtained from the Hypertension and Research Center (H&RC), Rangpur, Bangladesh, from January to December 2020. Based on the eligibility criteria, 2643 patients were included to constitute the PREDIcT-HTN cohort. Baseline data was retrieved from the H&RC registry, and five follow-up waves are planned yearly (2021–2025). A questionnaire will be administered at each follow-up visit on hypertension control status, behavioral factors, quality of life, dietary adherence, and high blood pressure compliance-related variables. The participant will be right censored if the patient develops MACE, death due to any cause, loss to follow-up, or at the end of the study. A proportional hazard model will identify the risk factors of MACE. Multinomial logistic regression analyses will be performed to determine the predictors of the hypertension control status by medication and dietary adherence after adjusting confounders.
Ethics and dissemination
The ethical approval for this study was obtained from the Institutional Review Board, North South University [Ref: 2019/OR-NSU/IRB-No.0902]. The participants will provide written consent to participate. The findings will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences and stakeholder communication.
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Affiliation(s)
- Ahmed Hossain
- Department of Public Health, North South University, Dhaka, Bangladesh
- Global Health Institute, North South University, Dhaka, Bangladesh
- * E-mail:
| | - Gias Uddin Ahsan
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Mohammad Zakir Hossain
- Hypertension & Research Centre, Rangpur, Bangladesh
- TMSS Medical College, Bogra, Bangladesh
| | | | | | - Adittya Arefin
- Global Health Institute, North South University, Dhaka, Bangladesh
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Reynard C, van den Berg P, Oliver G, Naguib MP, Sammut‐Powell C, McMillan B, Heagerty A, Body R. The prognostic value of emergency department measured hypertension: A systematic review and meta-analysis. Acad Emerg Med 2022; 29:344-353. [PMID: 34553441 DOI: 10.1111/acem.14324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The objective was to assess the prognostic value of hypertension detected in the emergency department (ED). METHODS The ED presents a unique opportunity to predict long-term cardiovascular disease (CVD) outcomes with its potential for high-footfall, and large-scale routine data collection applied to underserved patient populations. A systematic review and meta-analyses were conducted to assess the prognostic performance and feasibility of ED-measured hypertension as a risk factor for long-term CVD outcomes. We searched MEDLINE and Embase databases and gray literature sources. The target populations were undifferentiated ED patients. The prognostic factor of interest was hypertension. Feasibility outcomes included prevalence, reliability, and follow-up attendance. Meta-analyses were performed for feasibility using a random effect and exact likelihood. RESULTS The searches identified 1072 studies after title and abstract review, 53 studies had their full text assessed for eligibility, and 26 studies were included. Significant heterogeneity was identified, likely due to the international populations and differing study design. The meta-analyses estimate of prevalence for ED-measured hypertension was 0.31 (95% confidence interval 0.25-0.37). ED hypertension was persistent outside the ED (FE estimate of 0.50). The proportion of patients attending follow-up was low with an exact likelihood estimate of 0.41. Three studies examined the prognostic performance of hypertension and demonstrated an increased risk of long-term CVD outcomes. CONCLUSION Hypertension can be measured feasibly in the ED and consequently used in a long-term cardiovascular risk prediction model. There is an opportunity to intervene in targeted individuals, using routinely collected data.
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Affiliation(s)
- Charles Reynard
- Division of Cardiovascular Sciences University of Manchester Manchester UK
- Emergency Department Manchester Royal Infirmary Manchester University NHS Foundation Trust Manchester UK
| | | | - Govind Oliver
- Ysbyty Gwynedd Emergency Department Betsi Cadwaladr University Health Board Bangor UK
| | - Mina Peter Naguib
- Humanitarian and Conflict Response Institute University of Manchester Manchester UK
| | | | - Brian McMillan
- Centre for Primary Care and Health Services Research The University of Manchester Manchester UK
| | - Anthony Heagerty
- Division of Cardiovascular Sciences University of Manchester Manchester UK
| | - Richard Body
- Division of Cardiovascular Sciences University of Manchester Manchester UK
- Emergency Department Manchester Royal Infirmary Manchester University NHS Foundation Trust Manchester UK
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Mahwati Y, Nurrika D, Latief K. The Determinants of Undiagnosed Hypertension Among Indonesian Adults: A Cross-sectional Study Based on the 2014-2015 Indonesia Family Life Survey. J Prev Med Public Health 2022; 55:60-67. [PMID: 35135049 PMCID: PMC8841202 DOI: 10.3961/jpmph.21.500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives This study investigated the determinants of undiagnosed hypertension among Indonesian adults. Methods This study involved an analysis of secondary data from the 2014 Indonesia Family Life Survey (IFLS) on 5914 Indonesian adults (≥40 years). The determinant variables examined in this cross-sectional study were education level, monthly per capita expenditures (PCE), whether the participant experienced headaches in the morning, and other general health variables. The outcome variable was undiagnosed hypertension, which was defined as participants with hypertension who had not received a hypertension diagnosis from a health professional and had never been prescribed medication for treating hypertension. The data were analyzed using logistic regression. Results A total of 3322 participants (56.2%) were found to have undiagnosed hypertension. The odds ratios (ORs) and 95% confidence intervals (CIs) of undiagnosed hypertension were significantly higher among those who completed primary school or lower (OR, 1.60; 95% CI, 1.29 to 1.98), had low monthly PCE (OR, 1.28; 95% CI, 1.13 to 1.43), did not report experiencing headaches in the morning (OR, 1.97; 95% CI, 1.76 to 2.21), and reported a general health status of healthy (OR, 2.05; 95% CI, 1.82 to 2.30) than those who had a higher education level, had high monthly PCE, experienced headaches in the morning, and were unhealthy. Conclusions Education level, monthly PCE, the experience of headaches in the morning, and general health status were associated with undiagnosed hypertension. The monitoring system for detecting undiagnosed hypertension cases must be strengthened. Health promotion is also necessary to reduce the prevalence of undiagnosed hypertension.
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Affiliation(s)
- Yeni Mahwati
- Sekolah Tinggi Ilmu Kesehatan Dharma Husada, Bandung, Indonesia
- Ministry of Research, Technology and Higher Education, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, Indonesia
- Corresponding author: Yeni Mahwati Sekolah Tinggi Ilmu Kesehatan Dharma Husada, 77 Jalan Terusan Jakarta, Bandung 40291, Indonesia E-mail:
| | - Dieta Nurrika
- Ministry of Research, Technology and Higher Education, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, Indonesia
- Banten School of Health Science, South Tangerang, Indonesia
| | - Kamaluddin Latief
- Center for Family Welfare, Faculty of Public Health, University of Indonesia, Depok, Indonesia
- Global Health & Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Pakhare A, Joshi A, Anwar R, Dubey K, Kumar S, Atal S, Tiwari IR, Mayank V, Shrivastava N, Joshi R. Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India. BMJ Open 2021; 11:e045997. [PMID: 34362799 PMCID: PMC8351514 DOI: 10.1136/bmjopen-2020-045997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Hypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction. METHODS We conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities. RESULTS Of 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group. CONCLUSIONS This study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.
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Affiliation(s)
- Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Rasha Anwar
- NCD Urban Project, Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Khushbu Dubey
- NCD Urban Project, Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Shubham Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | | | - Vipul Mayank
- All India Institute of Medical Sciences, Bhopal, India
| | - Neelesh Shrivastava
- NCD Urban Project, Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Rajnish Joshi
- Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
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Mobile-Application-Based Interventions for Patients With Hypertension and Ischemic Heart Disease: A Systematic Review. J Nurs Res 2020; 28:e117. [PMID: 32501962 DOI: 10.1097/jnr.0000000000000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hypertension and ischemic heart disease are major causes of adult mortality. Related interventions to manage these conditions are important to implement during long, symptom-free periods. The recent proliferation of smartphones has spawned numerous health interventions that rely on mobile applications. PURPOSE This systematic review was designed to summarize and analyze research on interventions using mobile applications for patients with hypertension and ischemic heart disease. METHODS We searched for related studies published from January 2006 to August 2017 on MEDLINE, EMBASE, CINAHL, and three Korean databases. Seventeen studies were identified and evaluated against eligibility criteria that included a focus on patients with hypertension or ischemic heart disease and a discussion of the detailed effects of a mobile-app-based intervention. All of the identified studies were evaluated qualitatively using a methodology checklist. RESULTS Twelve of the 17 studies were deemed as of acceptable quality according to the Scottish Intercollegiate Guideline Network quality assessment. According to the National Institutes of Health quality assessment tool, one article was of fair quality and four articles were of poor quality. Monitoring, education, and reminders were identified as application interventions. The effects of the app interventions were analyzed according to physiological factors, cognitive and behavioral factors, and psychological factors. Of the seven studies that measured blood pressure in patients with hypertension, five studies reported that the app-based interventions reduced blood pressure. Two of three studies showed a significant decrease of body mass index in patients with ischemic heart disease after the app-based interventions compared to the control group. Five of seven studies reported a significant change in medication adherence. Several studies showed different outcomes according to the disease, but the limited number of eligible studies was insufficient to demonstrate a conclusive effect. CONCLUSIONS To ensure the long-term effects of mobile-application-based interventions, healthcare professionals should consider the functions of mobile applications. Moreover, because the focus of these interventions may differ based on the nature of the disease, it is recommended that the composition of interventions be tailored to the specific disease.
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Emergency Nursing Policy and Hypertension Awareness: an Integrative Review of the Literature. Curr Hypertens Rep 2019; 21:55. [PMID: 31134409 DOI: 10.1007/s11906-019-0953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW This study aims to systematically examine the literature on nursing policy and hypertension (HTN) awareness in the emergency department (ED). RECENT FINDINGS The electronic databases searched included Pubmed, OVID, CINAHL, and Web of Science. Studies were limited by adult, English language, and peer-reviewed articles published in the USA between the years 2015 and 2018. Our literature search allowed for quantitative and qualitative studies with a focus on nursing policy and adult patients treated in the ED who have HTN or elevated BP. Eight quantitative studies were retained for review and appraisal, and were rated to be of moderate quality evidence. Findings were summarized under three themes: BP reassessment, referral, and practice. The role of ED nurses in the screening and referral of this patient population remains largely uncharacterized. More robust trials are critically needed to improve practice and outcomes for patients with uncontrolled HTN. Clinical trials are needed to examine the efficacy of ED-based interventions on BP control, using multi-disciplinary samples of ED clinicians.
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Wilson TT, Williams-Johnson J, Gossel-Williams M, Goldberg EM, Wilks R, Dasgupta S, Gordon-Strachan GM, Williams EW, Levy PD. Elevated blood pressure and illness beliefs: a cross-sectional study of emergency department patients in Jamaica. Int J Emerg Med 2018; 11:30. [PMID: 29846823 PMCID: PMC5976560 DOI: 10.1186/s12245-018-0187-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/15/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Elevated blood pressure (BP) is common among emergency department (ED) patients. While some data exist on the association between ED BP and hypertension (HTN) in the USA, little is known about this relationship in Afro-Caribbean nations. The aim of the study was to evaluate the relationship between elevated systolic BP in the ED and a previous diagnosis of HTN, accounting for potential factors that could contribute to poor HTN control among those with a previous diagnosis: socioeconomic status, health-seeking behavior, underlying HTN illness beliefs, medication adherence, and perceived adherence self-efficacy. METHODS This was a cross-sectional survey over 6 weeks, from November 19 through December 30, 2014. Those surveyed were non-critically ill or injured adult ED patients (≥ 18 years) presenting to an Afro-Caribbean hospital. Descriptive statistics were derived for study patients as a whole, by HTN history and by presenting BP subgroup (with systolic BP ≥ 140 mmHg considered elevated). Data between groups were compared using chi-square and t tests, where appropriate. RESULTS A total of 307 patients were included: 145 (47.2%) had a prior history of HTN, 126 (41.4%) had elevated BP, and 89 (61.4%) of those presenting with elevated blood pressure had a previous diagnosis of HTN. Those with less formal education were significantly more likely to present with elevated BP (52.1 vs. 28.8% for those with some high school and 19.2% for those with a college education; p = 0.001). Among those with a history of HTN, only 56 (30.9%) had a normal presenting BP. Those with a history of HTN and normal ED presenting BP were no different from patients with elevated BP when comparing the in duration of HTN, medication compliance, location of usual follow-up care, and HTN-specific illness beliefs. CONCLUSIONS In this single-center study, two out of every five Jamaican ED patients had elevated presenting BP, the majority of whom had a previous diagnosis of HTN. Among those with a history of HTN, 60% had an elevated presenting BP. The ED can be an important location to identify patients with chronic disease in need of greater disease-specific education. Further studies should evaluate if brief interventions provided by ED medical staff improve HTN control in this patient population.
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Affiliation(s)
- Taneisha T. Wilson
- Alpert School of Medicine, Brown University, Emergency Medicine, Rhode Island Hospital, 55 Claverick St. #2, Providence, RI 02903 USA
- University Emergency Medicine Foundation, Kingston, Jamaica
| | - Jean Williams-Johnson
- University Hospital, University of the West Indies, Mona, Kingston, Jamaica
- The University Hospital of the West Indies, Mona, Kingston, West Indies Jamaica
| | - Maxine Gossel-Williams
- Department of Basic Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica
- The University of the West Indies, Mona, Kingston, West Indies Jamaica
| | - Elizabeth M. Goldberg
- Alpert School of Medicine, Brown University, Emergency Medicine, Rhode Island Hospital, 55 Claverick St. #2, Providence, RI 02903 USA
- University Emergency Medicine Foundation, Kingston, Jamaica
| | - Rainford Wilks
- The University of the West Indies, Mona, Kingston, West Indies Jamaica
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Shuvra Dasgupta
- University Hospital, University of the West Indies, Mona, Kingston, Jamaica
- The University Hospital of the West Indies, Mona, Kingston, West Indies Jamaica
| | | | - Eric W. Williams
- University Hospital, University of the West Indies, Mona, Kingston, Jamaica
- The University Hospital of the West Indies, Mona, Kingston, West Indies Jamaica
| | - Philip D. Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI USA
- Emergency Medicine, 6G4 University Health Center, Detroit, MI 48201 USA
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