Prevalence of elevated blood pressure in adult patients presenting to the emergency department

Abstract

Background and Purpose

For unclear reasons the blood pressure in acute stroke patients is elevated and falls over next few days. Stress in emergency department has been suggested as an etiology. To study this, we compared the prevalence of elevated blood pressure in adult patients presenting to the emergency department (ED) with hypertension related diseases.

Methods:

We used data from the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS). Patients with clinical conditions requiring specific management of elevated blood pressure, namely, stroke, acute coronary syndrome, heart failure and traumatic brain injury were selected using ICD-9CM primary codes. Prevalence of acute systolic blood pressure (BP) ≥140 mmHg and ≥180 mmHg, and, systolic and diastolic BP≥140/90 mmHg and ≥180/110 mmHg were compared across the clinical conditions listed above.

Results:

The prevalence of BP≥140/90 mmHg on presentation to ED was significantly higher for stroke patients (78%) compared to patients with heart failure (55%, p<0.05) and traumatic brain injury (42%, p<0.05). The difference was not significant compared to acute coronary syndrome (63%).

Conclusions:

The increased prevalence of abnormally elevated blood pressure in stroke patients presenting to the emergency departments may be explained by higher prevalence of hypertension in these patients but a stroke specific mechanism in the acute period is also possible.