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Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension

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Abstract

Introduction

Emergency departments (EDs) are critical sites for hypertension (HTN) screening. Home blood pressure (BP) monitoring (HBPM) is used routinely in outpatient settings, yet its utility after the ED visit for those with elevated BP in the ED is unclear.

Aim

In this pilot study, we assessed if HBPM could detect HTN in patients with elevated in-ED BP.

Methods

From September 2014 to July 2017, we recruited adult patients at an urban, academic ED with a triage BP ≥ 120/80 mmHg and no history of HTN into this prospective cohort observational study. After their ED visit, participants obtained BP measurements for two weeks using a validated HBPM. HTN was considered probable if the average HBPM BP was ≥ 135/85 mmHg. We calculated the proportion of participants whose ED BP measurement accurately predicted HTN using HBPM after discharge.

Results

Of 136 participants enrolled, 93 (68%) returned the HBPM with at least four home BP measurements [mean number of measurements obtained: 29 (SD: 17, range 4–59)]. Participants’ median age was 40 years-old (IQR 34–48); 55% were female, 19% were black, and 58% were white. Forty-six percent of participants with elevated in-ED BP had HTN in follow-up.

Conclusions

For patients with elevated BP in the ED, HBPM could be valuable for determining which patients have HTN and require expedient follow-up.

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Acknowledgements

We have received funding for this work from the Agency for Healthcare Research and Quality (T32 HS000011), Brown Emergency Medicine; and the Rhode Island Foundation.

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Authors and Affiliations

  1. Department of Emergency Medicine, Brown University, 55 Claverick Street, Providence, RI, 02903, USA

    Elizabeth M. Goldberg, Taneisha Wilson & Roland C. Merchant

  2. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA

    Elizabeth M. Goldberg

  3. New York Medical College, Valhalla, NY, USA

    Bianca Jambhekar

  4. Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Sarah J. Marks

  5. Alpert Medical School of Brown University, Providence, RI, USA

    Michael Boyajian & Roland C. Merchant

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  1. Elizabeth M. Goldberg
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Correspondence to Elizabeth M. Goldberg.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Goldberg, E.M., Wilson, T., Jambhekar, B. et al. Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension. High Blood Press Cardiovasc Prev 26, 45–53 (2019). https://doi.org/10.1007/s40292-019-00300-0

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