Hypertension in the ED: still an unrecognized problem.

Introduction: Hypertension is prevalent in the general population. Emergency Department (ED) follow-up studies show persistence of blood pressure elevations in up to 50% of patients, and ED screening for hypertension has been recommended. Blood pressure elevations are often ignored or attributed to pain or anxiety. Our purpose was to document the incidence and recognition of hypertension in the ED and to assess its relation to pain scores and age.

Methods: This was a retrospective study. Patients presenting to the ED during a 1-month period were included. Age, blood pressure, and pain scores were reviewed. Discharge instructions and diagnoses were assessed as to whether blood pressure was recognized or follow-up was recommended.

Results: There were 2821 patients. Fifteen percent were less than 18 years old. Twenty-six percent had an elevated blood pressure (40% of pediatric patients). There was no correlation between the distribution of pain scores in either children or adults. There was almost no recognition of the problem. Follow-up for elevated blood pressure was recommended in only 4%. Of these, only 46% actually received follow-up. Twenty-four percent of patients with elevated blood pressure received follow-up for other reasons. Blood pressure was still elevated in 47%.

Conclusion: Hypertension was a common problem in our patient population. Elevated blood pressure readings were almost uniformly ignored or unrecognized, particularly in children. There was no correlation of elevated blood pressure readings and acute pain scores. Elevated blood pressure readings should not be attributed solely to anxiety or acute pain on presentation.