Hypertension in the emergency department: a missed opportunity to screen for primary aldosteronism?
Authors: Rachel D Graven, Ignatius Lee, Jing Ren, Jun Yang, Diana Egerton-Warburton
Published in: Academic Emergency Medicine, 2023 October 29
Conclusions:
- To the researchers' knowledge, this study is the inaugural one to assess PA testing in hypertensive patients attending the ED.
- Over 40% of adults who visited the ED with hypertension complied with the prevailing criteria for PA testing, but only a small fraction were actually tested.
- The findings accentuate the need for enhanced awareness of PA within the ED setting, promoting strategic testing, referrals, and treatment, especially pertinent to those presenting with hypertensive emergencies. To gauge the feasibility and efficacy of such a practice, future prospective studies are essential.
Methods:
- The research consisted of a structured retrospective review of charts concerning adults who sought treatment at three EDs within an Australian tertiary health system from August 2019 to February 2020, citing hypertension as their primary complaint.
- Using electronic medical records, essential clinical parameters were extracted to ascertain if patients conformed to the PA testing criteria.
Results:
- Of the 418 patients that attended the EDs with recorded elevated blood pressure, 181 (or 43.3%) met the PA screening criteria. However, only 9 patients (2.2%) underwent PA testing.
- Patients who met the screening guidelines were generally older, had a more frequent incidence of conditions like type 2 diabetes, coronary artery disease, and congestive heart failure, consumed more antihypertensive drugs, and showcased a lower estimated glomerular filtration rate.
- Those tested for PA tended to be younger and had higher blood pressure at the time of their ED visit.
- Referrals to medical teams corresponded with a higher frequency of PA screening.
Graven, R.D., Lee, I., Ren, J., Yang, J. and Egerton-Warburton, D. (2023), Hypertension in the emergency department: a missed opportunity to screen for primary aldosteronism?. Acad Emerg Med. Accepted Author Manuscript. https://doi.org/10.1111/acem.14830