Karras David J, Ufberg Jacob W, Heilpern Katherine L, Cienki John J, Chiang William K, Wald Marlena M, Harrigan Richard A, Wald David A, Shayne Philip, Gaughan John, Kruus Linda K
Temple University School of Medicine, Philadelphia, PA 19140, USA.
Acad Emerg Med. 2005 Sep;12(9):835-43. doi: 10.1197/j.aem.2005.04.015.
There has been little systematic study of emergency department (ED) patients with elevated blood pressure (BP) values. The authors sought to characterize ED patients with elevated BP values, assess presenting symptoms, and determine the prevalence of elevated BP after discharge.
This was a cross-sectional study performed in four academic EDs. Adults presenting with systolic BP >or=140 mm Hg or diastolic BP >or=90 mm Hg were enrolled over a one-week equivalent period. Demographics, medical history, and symptoms were obtained by chart abstraction and structured interview. A random patient subset underwent a three-week follow-up interview. BP measurements were staged, using Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) criteria, according to the greatest value noted in the ED.
A total of 1,396 patients were enrolled. Stage 1 BP values were noted in 44.3%, stage 2 in 25.3%, and stage 3 in 30.3%. African American patients more frequently had stage 2 and 3 BP values than other ethnic groups. BP measurements were repeated in 61.1% of patients and were the same or greater in 51.3% of patients. Dyspnea was associated with greater BP values. Among the 63.9% of patients who were interviewed, 52.7% were not being treated for hypertension, and 42.1% of those with hypertension had recently missed a medication dose. Follow-up was obtained in 74.7% of those targeted. A visit to a medical practitioner since discharge was reported by 63.2%; of these, 26.1% reported that their BP remained elevated.
Elevated BP is common among ED patients. African American patients are more likely than those of other ethnic groups to have greater BP values. The ED visit may be a good opportunity to identify patients with unrecognized or poorly controlled hypertension.
对急诊科（ED）中血压（BP）值升高的患者进行的系统研究较少。作者试图对血压值升高的急诊科患者进行特征描述，评估其就诊时的症状，并确定出院后血压升高的患病率。
这是一项在四个学术性急诊科进行的横断面研究。在相当于一周的时间段内，纳入收缩压≥140 mmHg或舒张压≥90 mmHg的成年患者。通过病历摘要和结构化访谈获取人口统计学、病史和症状信息。对一个随机抽取的患者亚组进行为期三周的随访访谈。根据在急诊科记录到的最高血压值，采用美国高血压预防、检测、评估和治疗联合委员会（JNC-VI）标准对血压测量值进行分级。
共纳入1396例患者。1期血压值患者占44.3%，2期占25.3%，3期占30.3%。非裔美国患者比其他种族患者更常出现2期和3期血压值。61.1%的患者重复进行了血压测量，其中51.3%的患者血压值相同或更高。呼吸困难与更高的血压值相关。在接受访谈的63.9%的患者中，52.7%未接受高血压治疗，42.1%的高血压患者近期漏服过一次药物。74.7%的目标患者接受了随访。63.2%的患者报告出院后去看过医生；其中，26.1%的患者报告血压仍高。
血压升高在急诊科患者中很常见。非裔美国患者比其他种族患者更有可能出现更高的血压值。急诊科就诊可能是识别未被诊断或血压控制不佳的高血压患者的好机会。
