1 in 3 Heart-Related ER Visits Are Caused by Uncontrolled Blood Pressure
Many emergency room patients with heart problems have a type of high blood pressure that’s often caused by unhealthy habits, a new study suggests.
More than 1 in 10 adults treated for heart problems in U.S. emergency rooms have what’s known as essential hypertension, a type of high blood pressure that isn’t caused by a specific medical condition, a new study suggests.
Essential hypertension is the most common cause of heart-related emergencies for women, accounting for 16 percent of cases, and the second-most common cause for men, making up almost 11 percent of cases, according to study findings published September 8 in the Journal of the American Heart Association. The study examined nationally representative data on more than 20 million emergency department visits from 2016 to 2018.
The good news for patients is that most people treated in U.S. emergency rooms for essential hypertension and other heart problems survive. Overall, just 2.2 percent of patients die in the emergency room and only 1.7 percent of them die after being admitted to the hospital, the study found.
Just 2.7 percent of patients with essential hypertension were sick enough to get admitted to the hospital, and fewer than 0.1 percent of them died. This suggests that many of these emergency room visits for essential hypertension might have been avoided if people had better care before they got to the hospital, says the senior study author, Mamas Mamas, MBBS, DPhil, of the Centre for Prognosis Research at Keele University in Staffordshire, England.
“These visits were mostly related to the management of hypertension,” Dr. Mamas says.
What Is Essential Hypertension
Essential hypertension, also known as primary or idiopathic hypertension, isn’t caused by specific medical conditions or one distinct health issue, according to the Cleveland Clinic. Instead, it develops because of a combination of factors.
Some risk factors, such as advanced age or a family history of high blood pressure, can’t be avoided. But essential hypertension typically involves at least some unhealthy habits or lifestyle-related health issues, according to the Cleveland Clinic. Changes to or avoidance of the following behaviors may prevent or reverse essential hypertension.
- A high-salt diet
- Too much coffee or caffeine
- Heavy alcohol consumption
- A sedentary lifestyle with too little exercise
- Insomnia or other sleep problems
- Type 2 diabetes
- Obesity
In the new study, 35 percent of the participants were smokers, and this was the most common preventable risk factor for essential hypertension. Three in 10 people had type 2 diabetes and almost 13 percent had obesity, two conditions that might be improved or reversed to reduce the risk of essential hypertension.
One limitation of the study is that it relied on insurance claims data, which may not always accurately reflect patients’ complete medical histories or include all the health issues that bring them to the emergency room. Patient diagnoses were also determined when they were discharged from the emergency room, a point in time when the correct diagnosis might not yet be clear for some patients — especially people with more complex cases or multiple health issues.
Undiagnosed, Uncontrolled Hypertension
Even so, plenty of previous research suggests that it’s quite common for patients to have undiagnosed or poorly managed high blood pressure. Roughly half of the 75 million Americans who have high blood pressure don’t have the condition under control, according to the U.S. Department of Health and Human Services. And about 11 million of these people don’t know their blood pressure is elevated and are not getting treatment to manage it.
A study published in March 2020 in Family and Community Health found that a lack of accessible or affordable care isn’t necessarily driving the lack of treatment: Researchers found that three in four people with undiagnosed hypertension had health insurance. So-called hidden hypertension accounts for 72 percent of cases among people under 35 years old, and 57 percent of cases in people 36 to 49, this study also found. Hidden hypertension makes up two-thirds of cases among people at a normal body weight.
Even when people are prescribed medication to lower their blood pressure, only two in five of them achieve well-controlled blood pressure, another U.S. study in the September 2020 International Journal of Cardiology Hypertension found.
“Both lack of awareness and lack of treatment contribute to uncontrolled blood pressure,” says Mitchell Elkind, MD, the chief clinical science officer of the American Heart Association and a professor of neurology and epidemiology at Columbia University in New York City.
“Hypertension is often called the silent killer because people are not aware they have it until they have a stroke, heart attack, or other adverse event,” says Dr. Elkind, who wasn’t involved in the new study. “Lack of awareness and lack of access to medical care through adequate insurance are particularly problematic among communities of color and marginalized communities.”
Managing High Blood Pressure
Blood pressure readings under about 120/80 millimeters of mercury (mmHg) are normal, according to the CDC. People are typically diagnosed with high blood pressure when they consistently have readings that are at least 130/80 mmHg, according to the CDC.
For many people newly diagnosed with high blood pressure, lifestyle changes are the first thing doctors prescribe. Some approaches recommended by the CDC include:
- Get at least 150 minutes of physical activity each week (about 30 minutes a day, 5 days a week).
- Don't smoke.
- Eat a healthy diet that includes plenty of fresh fruits and veggies and limits salt and alcohol.
- Maintain a healthy weight.
- Manage stress.
Many people also take medication to lower their blood pressure. Doctors may prescribe a wide variety of drugs alone or in combination including diuretics to rid the body of excess sodium and water, beta-blockers to lower heart rate, and ACE inhibitors to help blood vessels widen and relax, according to the American Heart Association (AHA).
“Some patients may be able to control their blood pressure through weight loss, dietary changes such as reducing salt intake, or avoidance of alcohol,” Elkind says. “For others, medications may be needed; fortunately we have many safe and effective medications to choose from.”