CLINICAL CHARACTERISTICS, OFFICE BLOOD PRESSURE, AND HOME BLOOD PRESSURE OF PATIENTS DIAGNOSED WITH HYPERTENSION IN THE EMERGENCY DEPARTMENT

Year 2023, , 454 - 464, 23.09.2023

Fuat Polat , Zeynettin Kaya , Mehmet Ali Özbek , İsmail Ateş

https://doi.org/10.17343/sdutfd.1336150

Abstract

Objective
This study aimed to investigate the characteristics of
patients presenting to the emergency department (ED)
with high blood pressure for the first time, comparing
their blood pressure measurements in the ED, office,
and home settings, and evaluating the diagnostic
value for hypertension.
Material and Method
A total of 109 patients with no previous history of
hypertension, presenting with various symptoms,
were included. Baseline characteristics and blood
pressure measurements in the ED, office, and home
were analyzed.
Results:
The study population (mean age: 48.5±12.9 years,
44% male) had a mean systolic blood pressure (SBP)
of 166.87 (±16.24) mmHg and mean diastolic blood
pressure (DBP) of 94.95 (±11.98) mmHg in the ED.
SBP and DBP measured in the ED were significantly
higher than office and home measurements
(p<0.001). According to both office and home blood
pressure measurements, 56.9% of the patients were
hypertensive (SBP ≥140 and/or DBP ≥90 mmHg)
Significant correlations were found between SBP
and grade 1 or higher hypertensive retinopathy
(p=0.002), hypothyroidism (p=0.007), low hemoglobin
levels (p=0.026), high potassium levels (p=0.05), and
relative wall thickness (p=0.05). DBP was significantly
correlated with male gender (p=0.05), grade 1 or
higher hypertensive retinopathy (p=0.025), obesity
(p=0.037), and low hemoglobin levels (p=0.047).
Conclusion
Patients with initial high blood pressure in the ED
had lower blood pressure readings in the office and
at home. However, over half of these patients were
diagnosed with hypertension during follow-up. These
findings highlight the importance of considering the
setting of blood pressure measurements and the
need for follow-up evaluations to accurately diagnose
hypertension in ED patients presenting with high
blood pressure.

Keywords

Emergency department blood pressure, office blood pressure, home blood pressure

ACİL SERVİSTE HİPERTANSİYON TANISI ALAN HASTALARIN KLİNİK ÖZELLİKLERİ, OFİS TANSİYONLARI VE EV TANSİYONLARI

Abstract

Amaç
Bu çalışmanın amacı, acil servise ilk kez yüksek tansiyon
ile başvuran hastaların özelliklerini araştırmak,
acil servis, ofis ve ev ortamlarındaki kan basınç ölçümlerini
karşılaştırmak ve hipertansiyon için tanısal
değerini değerlendirmektir.
Gereç ve Yöntem
Daha önce hipertansiyon öyküsü olmayan, çeşitli
semptomlarla başvuran toplam 109 hasta dahil edildi.
Acil serviste, ofiste ve evde temel özellikler ve kan basıncı
ölçümleri analiz edildi.
Bulgular
Çalışma popülasyonunun (ortalama yaş: 48,5±12,9
yıl, %44 erkek) acil serviste ortalama sistolik kan
basıncı (SKB) 166,87 (±16,24) mmHg ve ortalama
diyastolik kan basıncı (DKB) 94,95 (±11,98) mmHg
idi. Acil serviste ölçülen SKB ve DKB, ofis ve ev ölçümlerinden
anlamlı olarak yüksekti (p<0.001). Hem
ofis hem de ev kan basıncı ölçümlerine göre hastaların
%56,9'u hipertansif (SKB ≥140 ve/veya DBP ≥90
mmHg) idi. SKB ile grade 1 ve üzeri hipertansif retinopati
(p=0,002), hipotiroidizm (p=0,007), düşük hemoglobin
düzeyi (p=0,026), yüksek potasyum düzeyi
(p=0,05) ve göreceli duvar kalınlığı ( p=0.05). DKB,
erkek cinsiyet (p=0,05), grade 1 ve üstü hipertansif
retinopati (p=0,025), obezite (p=0,037) ve düşük
hemoglobin düzeyi (p=0,047) ile anlamlı korelasyon
gösterdi.
Sonuç
Acil serviste başlangıçta yüksek tansiyonu olan hastalarda,
ofiste ve evde daha düşük tansiyon değerleri
vardı. Ancak bu hastaların yarısından fazlasına takip
sırasında hipertansiyon tanısı konmuştur. Bu bulgular,
yüksek tansiyon ile başvuran acil servis hastalarında
hipertansiyonu doğru bir şekilde teşhis etmek için kan
basıncı ölçümlerinin ayarlanmasının ve takip değerlendirmelerinin
dikkate alınmasının önemini vurgulamaktadır.

Keywords

Acil servis kan basıncı, ofis kan basıncı, ev kan basıncı

References

• 1. NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population- based measurement studies with 19.1 million participants. Lancet 2017;389:37–55.
• 2. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217–223.
• 3. Banegas JR, Lopez-Garcia E, Dallongeville J, Guallar E, Halcox JP, Borghi C, et al. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J 2011;32:2143–2152.
• 4. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. PURE Study Investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013;310:959–968.
• 5. Falaschetti E, Mindell J, Knott C, Poulter N. Hypertension management in England: a serial cross-sectional study from 1994 to 2011. Lancet 2014;383:1912–1919.
• 6. Tocci G, Rosei EA, Ambrosioni E, Borghi C, Ferri C, Ferrucci A, et al. Blood pressure control in Italy: analysis of clinical data from 2005-2011 surveys on hypertension. J Hypertens 2012;30:1065–1074.
• 7. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903–1913.
• 8. Lip GYH, Coca A, Kahan T, Boriani G, Manolis AS, Olsen MH, et al. Hypertension and cardiac arrhythmias: executive summary of a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE). Eur Heart J Cardiovasc Pharmacother 2017;3:235–250.
• 9. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green AL, Izzo JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560–72.
• 10. Goldman L, Cook EF. Decline in ischemic heart disease mortality rates: an analysis of the comparative effects of medical intervention and changes in lifestyle. Ann Intern Med 1984;101:825–36.
• 11. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351:1755–62.
• 12. Psaty BM, Smith NL, Siscovick DS, Koepsell TD, Weiss NS, Heckbert SR, et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. JAMA 1997;277:739–45.
• 13. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, et al. Blood pressure, stroke, and coronary disease. Part 2, short-term reductions in blood pressure: overview of randomized drug trials in their epidemiologic context. Lancet 1990;335:827–38.
• 14. Karras DJ, Ufberg JW, Heilpern KL, Cienki JJ, Chiang VK, Wald MM, et al. Elevated blood pressure in urban emergency department patients. Acad Emerg Med 2005;12(9):835–43.
• 15. Chiang WK, Jamshahi B. Asymptomatic hypertension in the ED. Am J Emerg Med 1998;16:701–4.
• 16. Preston RA, Baltodano NM, Cienki J, Materson BJ. Clinical presentation and management of patients with uncontrolled, severe hypertension: results from a public teaching hospital. J Hum Hypertens 1999;13:249–55.
• 17. Chernow SM, Iserson KV, Criss E. Use of the emergency department for hypertension screening: a prospective study. Ann Intern Med 1987;16:180–2
• 18. Pitts SR, Adams RP. Emergency department hypertension and regression to the mean. Ann Emerg Med 1998;31:214–8.
• 19. Friedman BW, Mistry B, West JR, Wollowitz A. The association between headache and elevated blood pressure among patients presenting to an ED. Am J Emerg Med 2014;32(9):976-981.
• 20. Backer HD, Decker L, Ackerson L. Reproducibility of increased blood pressure during an emergency department or urgent care visit. Ann Emerg Med 2003;41(4):507-512.
• 21. Poon SJ, Roumie CL, O’shea CJ, Fabbri D, Coco JR, Collins SP, et al. Association of elevated blood pressure in the emergency department with chronically elevated blood pressure. J Am Heart Assoc 2020;9(12).
• 22. Falkner B. Monitoring and management of hypertension with obesity in adolescents. Integr Blood Press Control 2017;10:33.
• 23. DellaCroce JT, Vitale AT. Hypertension and the eye. Curr Opin Ophthalmol 2008;19(6):493-498.
• 24. Song JJ, Ma Z, Wang J, Chen LX, Zhong JC. Gender Differences in Hypertension. J Cardiovasc Transl Res 2020;13(1):47-54.
• 25. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J 2018;39(33):3021-3104.
• 26. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults a report of the American College of Cardiology/American Heart Association Task Force on Clinical practice guidelines. Hypertension 2018;71(6):E13-E115.
• 27. Kim S, Chang Y, Kang J, Cho A, Cho J, Hong YS, et al. Relationship of the blood pressure categories, as defined by the ACC/AHA 2017 Blood Pressure Guidelines, and the risk of development of cardiovascular disease in low-risk young adults: insights from a retrospective cohort of young adults. J Am Heart Assoc 2019;8(11).
• 28. Lakkis JI, Weir MR. Hyperkalemia in the Hypertensive Patient. Curr Cardiol Rep 2018;20(2).