Differing prevalence estimates of elevated blood pressure in ED patients using 4 methods of categorization

Objective: This study examined the variability of blood pressure measurements and prevalence estimates of elevated blood pressure in emergency department (ED) patients using 4 different methods of categorization. Methods: A prospective, observational study was conducted on adult ED patients with elevated triage blood pressures (systolic ≥140 or diastolic ≥90 mm Hg). Three blood pressure measurements were obtained on all subjects and categorized as follows: (1) triage measurement only, (2) the mean of the triage and second measurement, (3) the mean of the 3 measurements, and (4) the mean of the second and third measurements. Results: Of 2192 screened patients, 326 were included in the final analysis with mean triage systolic and diastolic blood pressures of 160 and 90 mm Hg, respectively. Prevalence estimates of elevated blood pressure in this sample ranged from 100% (reference standard: mean triage blood pressure) to the most conservative estimate of 67% (fourth method). Conclusion: Determination of elevated blood pressure in ED patients is largely dependent on the method of blood pressure categorization.