High Blood Pressure Among Emergency Department Patients: Effects of Educational Intervention.

Introduction Hypertension is a significant global health issue. It is estimated that approximately half of adults in the United States have hypertension (approximately 119 million adults). Although emergent treatment is not indicated for asymptomatic hypertension, patients presenting to the emergency department (ED) with hypertension may represent an opportunity for patient education and improved health outcomes. This study was undertaken to identify healthcare outcomes associated with an educational intervention for patients presenting to the ED with hypertension. Methods In this prospective interventional study, subjects included consenting adult Emergency Department (ED) patients with hypertension (defined by the International Society of Hypertension as systolic blood pressure (BP) over 140 mm Hg and/or diastolic BP over 90 mm Hg), who were discharged home. Baseline assessment of medication adherence, exercise, diet, tobacco, and alcohol use was performed. An educational intervention was provided using the American Heart Association: Blood Pressure Fact Sheets. Subjects were contacted at two and four weeks following the ED visit to assess BP, medication adherence, exercise, diet, and tobacco and alcohol use. Results Among 151 participants, data were available at two weeks for 89 subjects (59% follow-up rate). Following the educational intervention, participants had lower systolic BP at two weeks (baseline mean: 163 mm Hg (95% CI: 159-166), two-week mean: 130 mm Hg (95% CI: 126-135); p < 0.001) and diastolic BP at two weeks (baseline mean: 93 (95% CI: 91-95); two-week mean: 77 mmHg (95% CI: 75-80); p < 0.001). Participants were more likely to take antihypertensive medication daily at two weeks (baseline: 52%; two-week mean: 69%; p = 0.0271). There was no significant difference in self-reported healthy diet (baseline: 21%; two-week mean: 26%; p = 0.1). There was no significant difference in self-reported exercise (baseline: 30%; two-week mean: 26%; p = 0.8). There were no differences in smoking or alcohol use at two weeks. Similar results were found at four weeks. Data were available at four weeks post intervention for 88 subjects (58.2% follow-up rate). At four weeks, participants had a lower systolic BP (baseline: 163 mmHg (95% CI: 159-166); four-week mean: 132; p < 0.001) and lower diastolic BP (baseline: 93 mmHg (95% CI: 91-95); four-week mean: 78; p < 0.001). A significant difference in self-reported exercise emerged at four weeks, with a lower percentage reporting no exercise (baseline reporting no exercise: 30%; four-week mean: 18%, p = 0.0348). There were no significant differences in reported healthy diet adherence (baseline: 21%; four-week mean: 24%; p = 0.6705), smoking (baseline: 11.92%; four-week mean: 5.68%; p = 0.1147), or alcohol use (baseline: 34%; four-week mean: 28%; p = 0.3361). Conclusions An educational intervention in the ED was associated with lower systolic and diastolic BP at two and four weeks post ED visit, improved medication adherence at two and four weeks, and self-reported exercise at four weeks. There were no differences in reported healthy diet adherence, exercise, smoking, or alcohol use.