A simple consultation during unrelated visits to the emergency room can help patients with high blood pressure — “the silent killer” — manage the condition, even before they experience symptoms, according to new research from the University of Illinois Chicago.
Also known as hypertension, high blood pressure is often called the silent killer because noticeable symptoms usually appear only when the disease has already progressed to serious complications.
For the study, published in JAMA Cardiology, UIC researchers enrolled more than 500 patients with elevated blood pressure who received care for a variety of reasons in the emergency department at UI Health, UIC’s health system. Before patients were discharged, a health care provider consulted with them about hypertension and provided them with a smartphone-paired blood pressure monitor for them to use over the next six months.
Those patients who received the intervention had significantly lower blood pressures six months after their emergency department visit than patients who didn’t. The findings suggest that incorporating simple interventions during emergency department visits can be an effective strategy for controlling hypertension, especially in patient populations who are disproportionately affected or may lack access to regular medical care.
“Emergency departments are the safety net of the health care system,” said lead author Dr. Heather Prendergast, professor of emergency medicine in the College of Medicine. Patients with less access to regular medical care often only interact with the health care system during emergency room visits, Prendergast said.
Typically, if a patient has elevated blood pressure as they’re being discharged from an emergency department visit, providers will advise them to make an appointment with their primary care doctor or a community health center like UI Health’s Mile Square Health Center if they don’t have one.
“Oftentimes, we find that patients do not follow up,” Prendergast said, especially if they’re not experiencing symptoms. If left uncontrolled, hypertension can lead to heart failure, kidney disease, strokes and more.
While almost half of all adults in the United States have high blood pressure, there are significant health disparities associated with the disease, and uunderrepresented groups tend to have higher rates and worse outcomes. Based on UI Health’s patient population, 92% of the new study’s participants were from underrepresented backgrounds.
“This was predominantly a minority population, a very high-risk population and a population that is traditionally underrepresented in clinical trials,” Prendergast said. The study is the first of its kind funded by the NIH’s National Heart, Lung, and Blood Institute focused on this particular patient population in the emergency department setting, she added.
When Prendergast and colleagues began the study, the rates of uncontrolled hypertension in UI Health’s primary service area were higher than the national average. Through a combination of efforts including the emergency department-based intervention, the patient population served by UI Health now has hypertension rates slightly better than the national average, Prendergast said. The combined efforts exemplify UIC’s commitment to improving the health of local populations in Chicago, she said. “We are really committed to improving the health and well-being of the community we serve,” she said.
“What was most exciting to me was when we had a post-trial survey with the participants, over 90% of them said that they would recommend this study to their family and friends, and more importantly, that they felt more empowered or knowledgeable about how to manage their blood pressure,” Prendergast said.
Next, Prendergast and her colleagues will test the intervention in five other emergency departments in different states. “My goal is to see these interventions become standard of care. Instead of just giving a patient a referral and telling them to call and make an appointment, maybe we could equip them with better tools.”
In addition to Prendergast, UIC co-authors on the study include Spyros Kitsiou, Renee Petzel Gimbar, Sally Freels, Anissa Sanders, Dr. Martha Daviglus, Dr. Pavitra Kotini-Shah and Shaveta Khosla.
