More Hypertension Seen in ED than in Doctor's Office By Kristina Fiore, Staff Writer, MedPage Today

Elevated blood pressure readings are much more common at emergency department visits than in visits to primary care offices, government researchers said.

Over one year, 43.5% of emergency department (ED) patients had either moderately or severely elevated blood pressure, compared with 27% of patients seen in their regular physician's office, Richard Niska, MD, MPH, of the CDC, reported in a National Center for Health Statistics data brief.

The difference may be due to the fact that "adults in less than optimal general health are more likely to use the ED than those in good health," Niska wrote.

Since elevated blood pressure in the ED may reflect underlying hypertension, he said, emergency department visits "could provide opportunities to address elevated blood pressure through patient education, initial treatment, and referral to primary care as deemed clinically appropriate."

For the study, Niska looked at data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) ED visit files from 2007 to 2008, and for comparison, at the NHAMCS OPD and National Ambulatory Medical Care Survey (NAMCS) physician office files from the same time period.

Severely elevated levels were defined as systolic blood pressure 160 mm Hg or above and diastolic pressure of 100 mm Hg or above. Moderately elevated levels involved a systolic reading of 140 to 159 mm Hg or a diastolic reading of 90 to 99 mm Hg.

Niska found that blood pressure is severely elevated at 16.3% and moderately elevated at 27.2% of emergency department visits, compared with 6.8% and 20.2%, respectively, of primary care office visits.

Older patients, men, blacks, Medicare beneficiaries, and the uninsured were disproportionately affected, Niska wrote.

The prevalence of severely elevated blood pressure increased significantly with rising age, up until age 65, and moderately increased levels rose significantly up until age 45.

As well, prevalence of both severely and moderately elevated blood pressure in the ED was higher in men than in women, he reported.

Severely elevated pressure in the ED was more common in non-Hispanic black patients than non-Hispanic whites or Hispanics (19.7% versus 15.3% and 15.3%, respectively).

It was also more common for Medicare beneficiaries than those with private insurance or Medicaid (19.6% versus 16.3% and 14.1%, respectively).

Prevalence of moderately elevated pressure in the ED was lowest among Medicaid beneficiaries, and was significantly greater among those with private insurance and the uninsured, Niska found.