Fleming J, Meredith C, Henry J
Academic Department of Accident and Emergency Medicine, Imperial College, St Mary's Hospital, London W2 1NY, UK.
Emerg Med J. 2005 Sep;22(9):636-40. doi: 10.1136/emj.2004.015040.
To assess whether an emergency department (ED) is a suitable location for the targeted screening of hypertension.
This was a prospective targeted screening study based at the ED of an inner city teaching hospital. Non-acute subjects over 18 years were recruited consecutively from the "minors" section of the ED and invited to participate. All subjects had their blood pressure measured twice. A verbal numerical pain score (PS) out of 10 using a visual analogue scale was obtained. Those with a mean systolic blood pressure > 140 mmHg or a mean diastolic blood pressure > 90 mmHg (WHO JNC stage 1 hypertension) were invited for a subsequent follow up measurement. The primary outcome measure was the proportion of subjects with hypertension at follow up. The secondary outcome measure was the correlation between a subject's mid blood pressure (MBP) and their PS.
In total, 765 subjects were tested, of whom 213 subjects were hypertensive at presentation (28.7%). After excluding those on anti-hypertensive medication (n = 43; 5.6%) and those who were non-UK residents (n = 44; 5.8%), 126 subjects were invited for follow up, of whom 51 subjects actually attended (40% attendance, 6.6% of study population). The MBP of those who re-attended was significantly lower than at presentation (p < 0.001); 39 subjects (5% of the study population, 76.4% of those attending follow up) remained hypertensive. There was no correlation between a subject's PS and their MBP (Pearson correlation coefficient = -0.02). A 10/10 PS was associated with an 8.4 mmHg rise in MBP compared to the mean MBP of subjects with PS 0-9 (p < 0.1). Of those originally presenting with PS > 5/10, 62% still had hypertension at follow up when the painful stimulus was significantly reduced (mean PS = 0.6).
The ED provides an opportunity for identifying those individuals with hypertension who may otherwise remain undiagnosed. Caution is advised when diagnosing hypertension in those individuals suffering from anxiety and/or acute severe pain on presentation.
评估急诊科是否是进行高血压靶向筛查的合适场所。
这是一项以前瞻性靶向筛查为基础的研究，研究地点为市中心一家教学医院的急诊科。从急诊科的“非急症患者”区域连续招募18岁以上的非急性病患者并邀请其参与研究。所有受试者均测量两次血压。使用视觉模拟量表获得0至10分的言语数字疼痛评分（PS）。收缩压均值>140 mmHg或舒张压均值>90 mmHg（世界卫生组织高血压防治指南第1期高血压）的受试者被邀请进行后续随访测量。主要结局指标是随访时高血压患者的比例。次要结局指标是受试者的平均血压（MBP）与其PS之间的相关性。
总共对765名受试者进行了检测，其中213名受试者初诊时患有高血压（28.7%）。排除正在服用抗高血压药物的受试者（n = 43；5.6%）和非英国居民（n = 44；5.8%）后，邀请126名受试者进行随访，其中51名受试者实际前来（随访参与率40%，占研究人群的6.6%）。再次前来的受试者的MBP显著低于初诊时（p < 0.001）；39名受试者（占研究人群的5%，占随访受试者的76.4%）仍患有高血压。受试者的PS与其MBP之间无相关性（Pearson相关系数 = -0.02）。与PS为0 - 9的受试者的平均MBP相比，PS为10/10的受试者的MBP升高了8.4 mmHg（p < 0.1）。在最初PS>5/10的受试者中，当疼痛刺激显著减轻时（平均PS = 0.6），62%的受试者在随访时仍患有高血压。
急诊科为识别那些可能未被诊断出患有高血压的个体提供了机会。对于就诊时患有焦虑症和/或急性剧痛的个体，在诊断高血压时建议谨慎。
