Laird Harrison

September 11, 2014

The number of people visiting US emergency rooms for essential hypertension surged by 25% from 2005 to 2011, a new study shows[1].

"A 25% increase is a huge jump," lead author said Dr Sourabh Aggarwal (Western Michigan University School of Medicine, Kalamazoo) told heartwire . "It was kind of surprising. We think we're doing a better job, and the number is going up, which is a problem for healthcare spending."

Aggarwal presented the study at the American Heart Association (AHA) High Blood Pressure Research Scientific Sessions 2014 .

Aggarwal said he had noticed an increase in visits for hypertension in his own practice and wanted to know if this was part of a larger trend.

He and his colleagues used Nationwide Emergency Department Sample data to find data on patients who visited emergency departments with first listed diagnosis of hypertension.

Researchers collected data on about 3.9 million emergency-room visits in 2006 and 2011 in which essential hypertension was the first listed diagnosis.

They then compared the number of these visits with the population served by these emergency departments, using US Census data.

They found that the rate of visits for hypertension increased significantly. On the other hand, they found that the rate at which these patients were admitted decreased significantly.

The researchers also identified 1 429 308 emergency-room visits with first listed diagnoses of "hypertension with complications and secondary hypertension." For these patients, the visits also increased while admissions decreased.

The researchers did not find a significant change in mortality.

Hypertension Visits to Emergency Rooms

Diagnosis Visits 2006 (per 100 000 population) Visits 2011 (per 100 000 population) p for change Admission rate 2006 (%) Admission rate 2011 (%) p for change
Essential hypertension 190.1 238.5 0.01 10.47 8.85 0.01
Hypertension with complications and secondary hypertension 71.2 84.7 0.01 77.79 68.75 0.01

Aggarwal said the data didn't give any clues about why the rate of visits is increasing. "There can be various theories," he said. "Maybe patients are not following their physicians' recommendations. Or maybe these are patients who don't have primary-care physicians. This is something that should be looked into."

The study reinforces previous research suggesting that 53% of Americans with known hypertension do not control the condition, said AHA spokesperson Dr Mary Ann Bauman (Integris Health, Oklahoma City, OK).

"We really need to understand why people don't take their blood pressure seriously," she said in an interview.

One reason patients don't stick to their medications may be that they don't experience symptoms from hypertension until it reaches a crisis point, she said, and they may fear side effects from drugs.

But inexpensive medications are now available and can be managed to avoid adverse reactions, so physicians need to be persistent in finding combinations that work for their patients, she said.

She recommended the AHA's Check, Change, Control Blood Pressure program in which patients closely track their blood pressure for four months.

"We find that after four months the benefits last for over a year," said Bauman. "What that tells us that people getting involved with checking their blood pressure and being accountable for it helps keep it under control."

Neither Aggarwal nor Bauman has reported any relevant financial relationships.

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