In November 2017, the American Heart Association (AHA) revised their hypertension (HTN) guidelines, decreasing the criteria for diagnosis and target for blood pressure (BP) control to 130/80 mmHg. This change has markedly increased the number of Americans who are affected by HTN and the proportion whose BP will be considered uncontrolled. There is increasing emphasis in emergency departments (EDs) on improving management of chronic diseases such as HTN making the reliability of BP measurement important. The objective of this study was to evaluate the reliability of ED BP measurement for determining uncontrolled HTN based on the new guideline (NG), using repeat measurement in the ED via BpTRU as the gold standard.Methods:
Data were collected as part of an on-going, prospective HTN registry for 338 participants who visited one of our three urban EDs and were identified as having a previous diagnosis of HTN. In addition to demographic data, triage BP was recorded along with a repeat BP using the BpTRU device. Descriptive analysis was performed using SAS version 9.4 and Tableau version 10.4.Results:
Of the 338 participants (mean age 45 years [13.4], 37 % male, 95 % African American; mean BP at triage = 163/98 mm Hg; mean BP by BpTru = 151/96 mm Hg), 295 (87.3%) were considered uncontrolled using triage BP by OG compared to 313 (92.6%) under NG. Measurements collected using BpTRU showed that 219 (64.8%) were uncontrolled by OG, while 263 (77.8%) were uncontrolled using NG criteria.Conclusion:
Based on NG criteria, more ED patients were found to have uncontrolled BP. However, use of BpTRU reduced the proportion with a BP above established criteria, suggesting that this approach to evaluation of patients with HTN may be beneficial in the effort to address the burden of chronic disease management.