Routine testing in patients with asymptomatic elevated blood pressure in the ED☆
Received 31 July 2008; received in revised form 11 November 2008; accepted 12 November 2008.
Abstract
Study Objective
There are no clear recommendations for the diagnostic evaluation of patients who present to the emergency department (ED) with asymptomatic elevated blood pressure. In patients presenting with asymptomatic elevated blood pressure in the ED, we measured the prevalence of abnormalities on a basic metabolic profile (BMP) that led to hospital admission as well as the prevalence of diminished renal function.
Methods
This is a cross-sectional study at 2 urban teaching EDs with a largely African American population. Adult patients (≥18 years) with a triage diastolic blood pressure (BP) 100 mm Hg or higher and without symptoms suggestive of acute end-organ damage were enrolled. All patients had a BMP sent. The primary outcome measured was abnormalities on the BMP that led to hospital admission. The secondary outcome measured was the prevalence of diminished renal function (glomerular filtration rate <60 mL min−1 1.73 m−2).
Results
One hundred sixty-seven patients with asymptomatic elevated BP were studied. Twelve (7.2%; 95% confidence interval, 3%-11%) patients were admitted due to abnormal results on the BMP. Twenty-seven (16.2%; 95% confidence interval, 11%-21%) patients met the secondary outcome measure of diminished renal function (glomerular filtration rate <60 mL min−1 1.73 m−2).
Conclusion
In a homogenous African American population presenting to the ED with asymptomatic elevated BP, there is a relatively high prevalence of abnormalities on the BMP that led to hospital admission. We suggest routine testing of a serum creatinine should be strongly considered in a largely African American patient population with asymptomatic elevated BP in the ED.
Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, US
Corresponding author. Department of Emergency Medicine, UC Davis Medical Center, Sacramento, CA 95817, USA. Tel.: +1 916 734 1376; fax: +1 916 734 7950.
☆ The study was presented at the SAEM Regional Meeting at the NY Academy of Medicine, NY, NY, on April 30, 2008, and at the SAEM National Meeting in Washington, DC, on May 30, 2008.
ABSTRACT