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Katherine L. Heilpern - One of the best experts on this subject based on the ideXlab platform.
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Evaluation and Treatment of Patients With Severely Elevated Blood Pressure in Academic Emergency Departments: A Multicenter Study
Annals of emergency medicine, 2006Co-Authors: David J. Karras, Linda K. Kruus, John J. Cienki, Marlena M. Wald, William K. Chiang, Philip Shayne, Jacob W. Ufberg, Richard A. Harrigan, David A. Wald, Katherine L. HeilpernAbstract:Study objective Current guidelines advise that emergency department (ED) patients with severely Elevated Blood Pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely Elevated Blood Pressure. Methods Observational study performed during 1 week at 4 urban, academic EDs. Severely Elevated Blood Pressure was defined as systolic Blood Pressure greater than or equal to 180 mm Hg or diastolic Blood Pressure greater than or equal to 110 mm Hg on at least 1 measurement. ED staff were blinded to the study purpose. Demographics, presenting complaints, vital signs, tests ordered, medications administered, disposition, and discharge instructions were recorded, and associations were tested in bivariate analyses. Results Severely Elevated Blood Pressure was noted in 423 patients. Serum chemistry was obtained in 73% of patients, ECG in 53% of patients, chest radiograph in 46% of patients, urinalysis in 43% of patients, and funduscopy documented in 36% of patients. All studies were performed in 6% of patients and were associated with complaints of dyspnea (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.1 to 8.7) and chest pain (OR 3.0; 95% CI 1.2 to 7.6). Oral antihypertensives were administered to 36% of patients and were associated with Blood Pressure–related complaints (OR 2.0 [1.2 to 3.3]), patient-suspected severely Elevated Blood Pressure (OR 5.6, 95% CI 2.0 to 15.3), and being uninsured (OR 2.0; 95% CI 1.2 to 3.3). Intravenous antihypertensives were given to 4% of patients, associated only with chest pain (OR 3.2; 95% CI 1.1 to 9.5). Modification of antihypertensive regimen was documented in 19% of discharged patients and associated with patient-suspected severely Elevated Blood Pressure (OR 5.5; 95% CI 2.5 to 12.2) and being uninsured (OR 1.8; 95% CI 1.1 to 2.9). Conclusion The majority of ED patients with severely Elevated Blood Pressure do not receive the evaluation, medical regimen modification, and discharge instructions advised by current guidelines. Further study is necessary to determine whether these recommendations are appropriate in this setting.
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Elevated Blood Pressure in urban emergency department patients
Academic Emergency Medicine, 2005Co-Authors: David J. Karras, John J. Cienki, Marlena M. Wald, William K. Chiang, Philip Shayne, Jacob W. Ufberg, Richard A. Harrigan, David A. Wald, Katherine L. Heilpern, John P GaughanAbstract:Objectives: There has been little systematic study of emergency department (ED) patients with Elevated Blood Pressure (BP) values. The authors sought to characterize ED patients with Elevated BP values, assess presenting symptoms, and determine the prevalence of Elevated BP after discharge. Methods: This was a cross-sectional study performed in four academic EDs. Adults presenting with systolic BP $140 mm Hg or diastolic BP $90 mm Hg were enrolled over a one-week equivalent period. Demographics, medical history, and symptoms were obtained by chart abstraction and structured interview. A random patient subset underwent a three-week follow-up interview. BP measurements were staged, using Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) criteria, according to the greatest value noted in the ED. Results: A total of 1,396 patients were enrolled. Stage 1 BP values were noted in 44.3%, stage 2 in 25.3%, and stage 3 in 30.3%. African American patients more frequently had stage 2 and 3 BP values than other ethnic groups. BP measurements were repeated in 61.1% of patients and were the same or greater in 51.3% of patients. Dyspnea was associated with greater BP values. Among the 63.9% of patients who were inter- viewed, 52.7% were not being treated for hypertension, and 42.1% of those with hypertension had recently missed a medication dose. Follow-up was obtained in 74.7% of those targeted. A visit to a medical practitioner since discharge was reported by 63.2%; of these, 26.1% reported that their BP remained Elevated. Conclusions: Elevated BP is common among ED patients. African American patients are more likely than those of other ethnic groups to have greater BP values. The ED visit may be a good opportunity to identify patients with unrecognized or poorly controlled hyperten-
Lauren Lawson - One of the best experts on this subject based on the ideXlab platform.
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Severely Elevated Blood Pressure: when is it an emergency?
The Journal of cardiovascular nursing, 2011Co-Authors: Lauren LawsonAbstract:High Blood Pressure is one of the most common chronic medical conditions in this country, occurring in about 1 of every 3 adults. It is not uncommon for nurses to see individuals in the emergency room, hospital, home, or other settings who have severely Elevated Blood Pressure readings. Extremely Elevated readings generally evoke considerable concern among healthcare staff. They are faced with deciding whether the individual requires immediate treatment and a higher level of care, such as transport to an emergency department. Severely Elevated Blood Pressure can be a true medical emergency, may require urgent care, or may in fact be a nonemergency. The purpose of this article is to assist nurses in recognizing those situations in which severely Elevated Blood Pressure requires immediate intervention. Current research and best evidence regarding severely Elevated Blood Pressure are presented.
Chien Chang Liao - One of the best experts on this subject based on the ideXlab platform.
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Waist to height ratio and Elevated Blood Pressure among children in Taiwan.
Indian pediatrics, 2012Co-Authors: Ta-liang Chen, Cheuk Sing Choy, Wan Yu Chan, Chien Hsin Chen, Chien Chang LiaoAbstract:Objectives To study the association of waist-to-height ratio (WHtR) and Elevated Blood Pressure (BP) in children.
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Waist circumference and risk of Elevated Blood Pressure in children: a cross-sectional study
BMC public health, 2011Co-Authors: Cheuk Sing Choy, Wan Yu Chan, Ta-liang Chen, Chun Chuan Shih, Chien Chang LiaoAbstract:Background: Increasing childhood obesity has become a major health threat. This cross-sectional study reports associations between schoolchildren’s waist circumference (WC) and risk of Elevated Blood Pressure. Methods: We measured height, weight, neck and waist circumference, and Blood Pressure in regular health examinations among children in grade 1 (ages 6-7 years) at six elementary schools in Taipei County, Taiwan. Elevated Blood Pressure was defined in children found to have mean systolic or diastolic Blood Pressure greater than or equal to the gender-, age-, and height-percentile-specific 95th-percentile Blood Pressure value. Results: All 2,334 schoolchildren were examined (response rate was 100% in the six schools). The mean of systolic and diastolic Blood Pressure increased as WC quartiles increased (p < 0.0001). The prevalence of Elevated Blood Pressure for boys and girls within the fourth quartile of waist circumference was 38.9% and 26.8%, respectively. In the multivariate logistic regression analyses, the adjusted odds ratios of Elevated Blood Pressure were 1.78 (95% confidence interval [CI] = 1.13-2.80), 2.45 (95% CI = 1.56-3.85), and 6.03 (95% CI = 3.59-10.1) for children in the second, third, and fourth waist circumference quartiles compared with the first quartile. The odds ratios for per-unit increase and per increase of standard deviation associated with Elevated Blood Pressure were 1.14 (95% CI = 1.101.18) and 2.22 (95% CI = 1.76-2.78), respectively. Conclusions: Elevated Blood Pressure in children was associated with waist circumference. Not only is waist circumference easier to measure than Blood Pressure, but it also provides important information on metabolic risk. Further research is needed on effective interventions to identify and monitor children with increased waist circumference to reduce metabolic and Blood Pressure risks.
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Hip Circumference and Risk of Elevated Blood Pressure in Children: A Cross-Sectional Study
Journal of Arrhythmia, 2011Co-Authors: Yi Chun Chou, Cheuk Sing Choy, Chien Chang LiaoAbstract:Background: The increasing rate of childhood obesity has become a major threat to children health. This study reports the association between hip circumference (HC) and risk of Elevated Blood Pressure in school children. Methods: We measured height, weight, neck circumference, HC, and Blood Pressure in regular health examinations among children in grade 1 at six elementary schools in Taipei, Taiwan. This study used age-, sex-, and height-specific criteria to define Elevated Blood Pressure. Results: Among 2,334 school children, the mean of Blood Pressure and the prevalence of Elevated Blood Pressure increased as HC quartiles increased (p
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Elevated Blood Pressure, Obesity, and Hyperlipidemia
The Journal of pediatrics, 2009Co-Authors: Chien Chang Liao, Kuo-liong Chien, Jou-kou Wang, Chuan Chi Chiang, Chau Ching Lin, Ruey S. Lin, Yuan-teh Lee, Fung Chang SungAbstract:Objectives To investigate the association of Blood Pressure elevation with body mass index (BMI) and total cholesterol levels in children who screened positive for proteinuria, glucosuria, and/or hamaturia. Study design From 1992 to 2000, a mass urine screening program was conducted annually for nearly 3 000 000 students aged 6 to 18 years. Of 99 350 students with positive results on urine tests, further examination found 17 548 students (17.7%) had Blood Pressure elevation. A case-control analysis was performed with randomly selected subjects with normal Blood Pressure who were frequency matched by sex and age. Results The adjusted odds ratio for Blood Pressure elevation in obese students was 3.45 (95% CI, 3.20-3.72), compared with students of normal weight. The odds ratio for Blood Pressure elevation increased to 6.15 (95% CI, 4.12-9.18) for students with a total cholesterol level ≥250 mg/dL and obesity, compared with students with a total cholesterol level Conclusion This study found a high prevalence of Elevated Blood Pressure in children with abnormal urinalysis results, with a strong association with BMI and total choleterol level.
David J. Karras - One of the best experts on this subject based on the ideXlab platform.
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Evaluation and Treatment of Patients With Severely Elevated Blood Pressure in Academic Emergency Departments: A Multicenter Study
Annals of emergency medicine, 2006Co-Authors: David J. Karras, Linda K. Kruus, John J. Cienki, Marlena M. Wald, William K. Chiang, Philip Shayne, Jacob W. Ufberg, Richard A. Harrigan, David A. Wald, Katherine L. HeilpernAbstract:Study objective Current guidelines advise that emergency department (ED) patients with severely Elevated Blood Pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely Elevated Blood Pressure. Methods Observational study performed during 1 week at 4 urban, academic EDs. Severely Elevated Blood Pressure was defined as systolic Blood Pressure greater than or equal to 180 mm Hg or diastolic Blood Pressure greater than or equal to 110 mm Hg on at least 1 measurement. ED staff were blinded to the study purpose. Demographics, presenting complaints, vital signs, tests ordered, medications administered, disposition, and discharge instructions were recorded, and associations were tested in bivariate analyses. Results Severely Elevated Blood Pressure was noted in 423 patients. Serum chemistry was obtained in 73% of patients, ECG in 53% of patients, chest radiograph in 46% of patients, urinalysis in 43% of patients, and funduscopy documented in 36% of patients. All studies were performed in 6% of patients and were associated with complaints of dyspnea (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.1 to 8.7) and chest pain (OR 3.0; 95% CI 1.2 to 7.6). Oral antihypertensives were administered to 36% of patients and were associated with Blood Pressure–related complaints (OR 2.0 [1.2 to 3.3]), patient-suspected severely Elevated Blood Pressure (OR 5.6, 95% CI 2.0 to 15.3), and being uninsured (OR 2.0; 95% CI 1.2 to 3.3). Intravenous antihypertensives were given to 4% of patients, associated only with chest pain (OR 3.2; 95% CI 1.1 to 9.5). Modification of antihypertensive regimen was documented in 19% of discharged patients and associated with patient-suspected severely Elevated Blood Pressure (OR 5.5; 95% CI 2.5 to 12.2) and being uninsured (OR 1.8; 95% CI 1.1 to 2.9). Conclusion The majority of ED patients with severely Elevated Blood Pressure do not receive the evaluation, medical regimen modification, and discharge instructions advised by current guidelines. Further study is necessary to determine whether these recommendations are appropriate in this setting.
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Elevated Blood Pressure in urban emergency department patients
Academic Emergency Medicine, 2005Co-Authors: David J. Karras, John J. Cienki, Marlena M. Wald, William K. Chiang, Philip Shayne, Jacob W. Ufberg, Richard A. Harrigan, David A. Wald, Katherine L. Heilpern, John P GaughanAbstract:Objectives: There has been little systematic study of emergency department (ED) patients with Elevated Blood Pressure (BP) values. The authors sought to characterize ED patients with Elevated BP values, assess presenting symptoms, and determine the prevalence of Elevated BP after discharge. Methods: This was a cross-sectional study performed in four academic EDs. Adults presenting with systolic BP $140 mm Hg or diastolic BP $90 mm Hg were enrolled over a one-week equivalent period. Demographics, medical history, and symptoms were obtained by chart abstraction and structured interview. A random patient subset underwent a three-week follow-up interview. BP measurements were staged, using Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) criteria, according to the greatest value noted in the ED. Results: A total of 1,396 patients were enrolled. Stage 1 BP values were noted in 44.3%, stage 2 in 25.3%, and stage 3 in 30.3%. African American patients more frequently had stage 2 and 3 BP values than other ethnic groups. BP measurements were repeated in 61.1% of patients and were the same or greater in 51.3% of patients. Dyspnea was associated with greater BP values. Among the 63.9% of patients who were inter- viewed, 52.7% were not being treated for hypertension, and 42.1% of those with hypertension had recently missed a medication dose. Follow-up was obtained in 74.7% of those targeted. A visit to a medical practitioner since discharge was reported by 63.2%; of these, 26.1% reported that their BP remained Elevated. Conclusions: Elevated BP is common among ED patients. African American patients are more likely than those of other ethnic groups to have greater BP values. The ED visit may be a good opportunity to identify patients with unrecognized or poorly controlled hyperten-
Heather S. Lipkind - One of the best experts on this subject based on the ideXlab platform.
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Perinatal outcomes in women with Elevated Blood Pressure and stage 1 hypertension.
American journal of obstetrics and gynecology, 2020Co-Authors: Victoria Greenberg, Michelle Silasi, Lisbet S. Lundsberg, Jennifer Culhane, Uma M. Reddy, Caitlin Partridge, Heather S. LipkindAbstract:Background Hypertension was redefined in 2017 with lower diagnostic thresholds; Elevated Blood Pressure is defined as systolic Blood Pressure of 120 to 129 mm Hg with diastolic Blood Pressure of Objective This study aimed to determine whether Elevated Blood Pressure and stage 1 hypertension as newly defined by the 2017 American College of Cardiology and the American Heart Association guidelines are associated with an increased risk of hypertensive disorders of pregnancy and other adverse maternal and neonatal outcomes. Study Design In this retrospective cohort study, 18,801 women with singletons from 2013 to 2019 were categorized as normotensive, prehypertensive (Elevated Blood Pressure), stage 1 hypertensive, or chronic hypertensive. Women with ≥2 systolic Blood Pressures of 120 to 129 mm Hg before 20 weeks’ gestation were classified into the Elevated Blood Pressure group. Women with ≥2 systolic Blood Pressures of 130 to 139 mm Hg or ≥2 diastolic Blood Pressures of 80 to 89 mm Hg before 20 weeks’ gestation were assigned to the stage 1 hypertension group. Women were classified as chronic hypertensives if they had any of the following: ≥2 systolic Blood Pressure of ≥140 mm Hg or ≥2 diastolic Blood Pressure of ≥90 mm Hg before 20 weeks’ gestation, a history of chronic hypertension, or antihypertensive medication use before 20 weeks’ gestation. Women with pregestational diabetes, lupus, or Results Of the 18,801 women, 13,478 (71.7%) were normotensive, 2659 (14.1%) had Elevated Blood Pressure, 1384 (7.4%) were stage 1 hypertensive, and 1280 (6.8%) were chronic hypertensive. A dose-response relationship was observed: the risk of hypertensive disorders of pregnancy increased from 4.2% in normotensive women to 6.7% (adjusted odds ratio, 1.50; 95% confidence interval, 1.26–1.79) in women with Elevated Blood Pressure, to 10.9% (adjusted odds ratio, 2.54; 95% confidence interval, 2.09–3.08) in women with stage 1 hypertension, and 28.4% (adjusted odds ratio, 7.14; 95% confidence interval, 6.06–8.40) in women with chronic hypertension. Compared with normotensive women, women with stage 1 hypertension had an increased risk of neonatal intensive care unit admissions (15.8% vs 13.0%; adjusted odds ratio, 1.21; 95% confidence interval, 1.03–1.42), preterm birth at Conclusion Our study demonstrates that Elevated Blood Pressure and stage 1 hypertension, using the 2017 American College of Cardiology and the American Heart Association guideline definition, are associated with increased maternal and neonatal risk. This group of women warrants further investigation to determine whether pregnancy management can be altered to reduce maternal and neonatal morbidity.