Karras David J, Kruus Linda K, Cienki John J, Wald Marlena M, Chiang William K, Shayne Philip, Ufberg Jacob W, Harrigan Richard A, Wald David A, Heilpern Katherine L
Temple University School of Medicine, Philadelphia, PA 19140, USA.
Ann Emerg Med. 2006 Mar;47(3):230-6. doi: 10.1016/j.annemergmed.2005.11.001. Epub 2006 Jan 18.
Current guidelines advise that emergency department (ED) patients with severely elevated blood pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely elevated blood pressure.
Observational study performed during 1 week at 4 urban, academic EDs. Severely elevated blood pressure was defined as systolic blood pressure greater than or equal to 180 mm Hg or diastolic blood pressure greater than or equal to 110 mm Hg on at least 1 measurement. ED staff were blinded to the study purpose. Demographics, presenting complaints, vital signs, tests ordered, medications administered, disposition, and discharge instructions were recorded, and associations were tested in bivariate analyses.
Severely elevated blood pressure was noted in 423 patients. Serum chemistry was obtained in 73% of patients, ECG in 53% of patients, chest radiograph in 46% of patients, urinalysis in 43% of patients, and funduscopy documented in 36% of patients. All studies were performed in 6% of patients and were associated with complaints of dyspnea (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.1 to 8.7) and chest pain (OR 3.0; 95% CI 1.2 to 7.6). Oral antihypertensives were administered to 36% of patients and were associated with blood pressure-related complaints (OR 2.0 [1.2 to 3.3]), patient-suspected severely elevated blood pressure (OR 5.6, 95% CI 2.0 to 15.3), and being uninsured (OR 2.0; 95% CI 1.2 to 3.3). Intravenous antihypertensives were given to 4% of patients, associated only with chest pain (OR 3.2; 95% CI 1.1 to 9.5). Modification of antihypertensive regimen was documented in 19% of discharged patients and associated with patient-suspected severely elevated blood pressure (OR 5.5; 95% CI 2.5 to 12.2) and being uninsured (OR 1.8; 95% CI 1.1 to 2.9).
The majority of ED patients with severely elevated blood pressure do not receive the evaluation, medical regimen modification, and discharge instructions advised by current guidelines. Further study is necessary to determine whether these recommendations are appropriate in this setting.
当前指南建议，应对急诊科（ED）中血压严重升高的患者进行急性靶器官损害评估，调整其治疗方案，并指导患者及时进行复诊以重新评估。我们研究了与血压严重升高患者接受推荐治疗情况相关的因素。
在4家城市学术性急诊科进行了为期1周的观察性研究。血压严重升高定义为至少1次测量的收缩压大于或等于180毫米汞柱或舒张压大于或等于110毫米汞柱。急诊科工作人员对研究目的不知情。记录了患者的人口统计学信息、就诊主诉、生命体征、所开检查、所用药、处置情况及出院指导，并在双变量分析中检验了相关性。
423例患者被发现血压严重升高。73%的患者进行了血清化学检查，53%的患者进行了心电图检查，46%的患者进行了胸部X光检查，43%的患者进行了尿液分析，36%的患者有眼底检查记录。所有检查均在6%的患者中进行，且与呼吸困难主诉（比值比[OR] 3.1；95%置信区间[CI] 1.1至8.7）和胸痛（OR 3.0；95% CI 1.2至7.6）相关。36%的患者接受了口服降压药治疗，这与血压相关主诉（OR 2.0 [1.2至3.3]）、患者怀疑血压严重升高（OR 5.6，95% CI 2.0至15.3）以及未参保（OR 2.0；95% CI 1.2至3.3）有关。4%的患者接受了静脉降压药治疗，仅与胸痛相关（OR 3.2；95% CI 1.1至9.5）。19%的出院患者有降压方案调整记录，这与患者怀疑血压严重升高（OR 5.5；95% CI 2.5至12.2）以及未参保（OR 1.8；95% CI 1.1至2.9）有关。
大多数血压严重升高的急诊科患者未接受当前指南建议的评估、治疗方案调整及出院指导。有必要进一步研究以确定这些建议在此情况下是否合适。
