Annals of Emergency Medicine
Volume 51, Issue 3 , Pages 221-229 , March 2008

Increased Blood Pressure in the Emergency Department: Pain, Anxiety, or Undiagnosed Hypertension?

Presented as a poster at the Society of Academic Emergency Medicine annual meeting, May 2006, San Francisco, CA; and the Society of Academic Emergency Medicine annual meeting, May 2007, Chicago, IL.

  • Paula Tanabe, PhD, MPH

      Affiliations

    • Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL
    • Corresponding Author InformationAddress for correspondence: Paula Tanabe, PhD, MPH, 417 S Jefferson, #408, Chicago IL, 60607; 312-926-6483, fax 312-926-6274
  • ,
  • Stephen D. Persell, MD, MPH

      Affiliations

    • Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL
  • ,
  • James G. Adams, MD

      Affiliations

    • Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL
  • ,
  • Jennifer C. McCormick, BA

      Affiliations

    • Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL
  • ,
  • Zoran Martinovich, PhD

      Affiliations

    • Mental Health Services and Policy Program, Feinberg School of Medicine, Northwestern University, Chicago IL.
  • ,
  • David W. Baker, MD, MPH

      Affiliations

    • Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL

Received 6 June 2007 ,Revised 11 September 2007 ,Accepted 15 October 2007.

References 

  1. Ong KL, Cheung BM, Man YB, et al. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension. 2007;49:69–75
  2. Chobabanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA. 2003;289:2560–2571
  3. Chobabanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252
  4. Decker WW, Godwin SA, Hess EP, et al. Clinical policy: critical issues in the evaluation and management of adult patients with asymptomatic hypertension in the emergency department. Ann Emerg Med. 2006;47:237–249
  5. Starchina YA, Parfenov VA, Chazova IE, et al. Cognitive function and the emotional state of stroke patients on antihypertensive therapy. Neurosci Behav Physiol. 2007;37:13–17
  6. Rhodus NL, Fricton J, Carlson P, et al. Oral symptoms associated with fibromyalgia syndrome. J Rheumatol. 2003;30:1841–1845
  7. Spielberger C, Gorsuch R, Lushene R, et al. State-Trait Anxiety Inventory for Adults. Redwood City, CA: Mind Garden; 1983;
  8. Little P, Barnett J, Barnsley L, et al. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. BMJ. 2002;325:258–259
  9. Longo D, Toffanin G, Garbelotto R, et al. Performance of the UA-787 oscillometric blood pressure monitor according to the European Society of Hypertension protocol. Blood Press Monit. 2003;8:91–95
  10. A & D Medical. Quick Response with EasyCuff Feature, Blood Pressure Monitor Trilingual Instruction Guide, Model UA-787. In: Milpitas, CA: A&D Medical; 2004;p. E-18
  11. Chatellier G, Dutrey-Dupagne C, Vaur L, et al. Home self blood pressure measurement in general practice (The SMART study. Self-measurement for the Assessment of the Response to Trandolapril). Am J Hypertens. 1996;9:644–652
  12. Hond ED, Celis H, Fagard R, et al. Self-measured versus ambulatory blood pressure in the diagnosis of hypertension. J Hypertens. 2003;21:717–722
  13. Bobrie G, Chatellier G, Genes N, et al. Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA. 2004;291:1342–1349
  14. Hozawa A, Shimazu T, Kuriyama S, et al. Benefit of home blood pressure measurement after a finding of high blood pressure at a community screening. J Hypertens. 2006;24:1265–1271
  15. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–1913
  16. Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345:1291–1297
  17. Miura K, Daviglus ML, Dyer AR, et al. Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: the Chicago Heart Association Detection Project in Industry. Arch Intern Med. 2001;161:1501–1508
  18. Kshirsagar AV, Carpenter M, Bang H, et al. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006;119:133–141
  19. Backer HD, Decker L, Ackerson L. Reproducibility of increased blood pressure during an emergency department or urgent care visit. Ann Emerg Med. 2003;41:507–512
  20. Chernow SM, Iserson KV, Criss E. Use of the emergency department for hypertension screening: a prospective study. Ann Emerg Med. 1987;16:180–182
  21. Cline D, Selvan V, Ferrario C, et al. Emergency department versus clinic follow-up blood pressures. Acad Emerg Med. 2006;13:S188
  22. Karras DJ, Ufberg JW, Heilpern KL, et al. Elevated blood pressure in urban emergency department patients. Acad Emerg Med. 2005;12:835–843
  23. Slater RN, DaCruz DJ, Jarrett LN. Detection of hypertension in accident and emergency departments. Arch Emerg Med. 1987;4:7–9
  24. Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population (Results from the Third National Health and Nutrition Examination Survey, 1988-1991). Hypertension. 1995;25:305–313
  25. Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA. 2005;294:466–472
  26. Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med. 2001;345:479–486
  27. Babcock Irvin C, Wyer PC, Gerson LW. Preventive care in the emergency department, part II: clinical preventive services—an emergency medicine evidence-based review (Society for Academic Emergency Medicine Public Health and Education Task Force Preventive Services Work Group). Acad Emerg Med. 2000;7:1042–1054
  28. Llovera I, Ward MF, Ryan JG, et al. A survey of the emergency department population and their interest in preventive health education. Acad Emerg Med. 2003;10:155–160
  29. Institute of Medicine. Institute of Medicine Committee on the Future of Emergency Care in the U.S. Health System Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: National Academies Press; 2006;

 Supervising editors: Keith A. Marrill, MD; Donald M. Yealy, MDAuthor contributions: PT had full access to all of the data in the study and takes full responsibility for the integrity of the data and the accuracy of the analysis. PT, JGA, and DWB were responsible for study concept and design. PT and JCM acquired the data. PT, SDP, JGA, ZM, and DWB were responsible for analysis and interpretation of data. PT and SDP were responsible for drafting of the article. JGA, JCM, DWB, and ZM were responsible for critical revision of the article for important intellectual content. PT and ZM were responsible for statistical analysis. PT obtained funding. PT and SDP were responsible for study supervision. PT takes responsibility for the paper as a whole.Funding and support: This study was funded by the Agency for Healthcare Research and Quality, RO3 HSO15619-01A1. The agency had no role in the development of the study, review of data, or role in manuscript development. Dr. Tanabe was supported also supported in part by the Northwestern Memorial Hospital Excellence in Academic Medicine grant.Publication dates: Available online January 18, 2008.Reprints not available from authors.

PII: S0196-0644(07)01670-8

doi: 10.1016/j.annemergmed.2007.10.017

Annals of Emergency Medicine
Volume 51, Issue 3 , Pages 221-229 , March 2008