Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Ann Emerg Med. 2018 Nov;72(5):534-543. doi: 10.1016/j.annemergmed.2018.06.002. Epub 2018 Jul 20.
Emergency department (ED) visits for hypertension are rapidly increasing. Hypertension guidelines began recommending use of self-measurement blood pressure (BP) devices in the early 2000s, which could be contributing to the increase. We aim to examine the proportion of ED visits for hypertension that occurred after a BP measurement with a self-measuring device, and the associated outcomes.
This retrospective observational study included adults who made an ED visit and received a primary diagnosis of hypertension at 1 of 5 community and tertiary hospitals in Ontario, Canada, between April 2010 and March 2011. We categorized ED visits into 4 groups: those made after a home BP reading, a pharmacy reading, as a result of a physician referral, and all others (termed "not documented"). We examined rates of admission to the hospital, ED treatment (administration of antihypertensive medication and prescription provision), and post-ED clinical events (follow-up care, return ED visits, and long-term all-cause mortality) by group.
Among 1,508 qualifying patients, median presenting ED BP was 182/97 mm Hg (interquartile range 164 to 200/85 to 109 mm Hg). The percentage of patients who presented to the ED after a reading at home, at a pharmacy, or by physician referral and the remaining patients not documented was 40.9%, 8.3%, 13.3%, and 37.5%, respectively. Overall, 109 patients (7.2%) were admitted to the hospital. The proportion of patients admitted after a home or pharmacy reading, after a physician referral, or who were not documented was 3.1%, 11.9%, and 11.0%, respectively. Two-year mortality rates were 5.4%, 0.0%, 6.5%, and 5.3% for the home, pharmacy, physician referral, and not documented groups, respectively. Among the 92.8% of patients who were discharged from the ED, 11% made another ED visit for hypertension within a year.
In this study, half of patients with an ED visit that was primarily for hypertension presented after elevated readings on self-measurement devices. Only 3% of these patients were admitted to the hospital.
高血压患者前往急诊部（ED）就诊的人数迅速增加。高血压指南于 21 世纪初开始推荐使用自我测量血压（BP）设备，这可能是导致就诊人数增加的原因之一。我们旨在研究因自我测量设备测量血压而导致的 ED 就诊中高血压患者的比例，以及相关的结局。
这是一项回顾性观察性研究，纳入了 2010 年 4 月至 2011 年 3 月期间在加拿大安大略省的 5 家社区和三级医院中，因高血压而在 ED 就诊并接受主要诊断的成年人。我们将 ED 就诊分为 4 组：在家中测量血压后就诊、在药店测量血压后就诊、因医生转诊就诊，以及其他所有情况（称为“未记录”）。我们通过组间比较，观察了住院、ED 治疗（使用降压药物和开具处方）以及 ED 就诊后的临床事件（随访护理、再次 ED 就诊和长期全因死亡率）的发生率。
在 1508 名符合条件的患者中，就诊时的中位 ED 血压为 182/97mmHg（四分位距 164 至 200/85 至 109mmHg）。在家中、药店或医生转诊后就诊的患者比例以及未记录的患者比例分别为 40.9%、8.3%、13.3%和 37.5%。总体而言，有 109 名患者（7.2%）被收治入院。在家中或药店测量血压后、医生转诊后以及未记录的患者中，分别有 3.1%、11.9%和 11.0%的患者被收治入院。在出院的 92.8%的患者中，有 11%的患者在一年内因高血压再次前往 ED 就诊。
在这项研究中，一半因 ED 就诊的高血压患者的就诊是因自我测量设备测量出的血压升高所致。这些患者中仅有 3%被收治入院。
