How Retail Clinicians Can Help Reduce Hypertension-Related Hospital Admissions

Rising hypertension-related emergency room (ER) visits provide an opportunity for retail clinicians to focus on treating and monitoring patients with high blood pressure.

Candace D. McNaughton, MD, MPH, FACEP, an assistant professor at Vanderbilt University Medical Center, toldContemporary Clinicthat physician assistants and nurse practitioners play vital roles in helping patients lower their blood pressure and avoid trips to the ER.

She added that high blood pressure is the main risk factor for cardiovascular disease and stroke.

“Whatever we as health care providers can do to help patients lower their blood pressure is going to be important and potentially life-saving,” she said.

In a recent study published inTheAmerican Journal of Cardiology, Dr. McNaughton and her colleagues found a “surprisingly high” proportion of hypertension-related ER visits.

Between 2006 and 2012, hypertension-related ER visits increased by around 5.2% per year, and the rate of visits with a primary diagnosis of hypertension rose by 4.4% per year, the researchers found.

Overall, hypertension was named in a diagnosis during more than one-fifth of all ER visits between 2006 and 2012.

The total number of hypertension-related visits was around 165 million (23.6% of all adult ER visits) between 2006 and 2012.

Around 6.3 million instances led to a primary diagnoses of hypertension, while secondary diagnoses of hypertension were accompanied by primary diagnoses of chest pain, pneumonia, urinary tract infection, syncope and collapse, and heart failure.

In co-occurring diagnosis codes, the other condition besides hypertension was often diabetes, headache, heart failure, and hyperlipidemia.

The researchers found that more than half of hypertension-related ER visits involved women.

ER visits related to hypertension were also more common in the South, followed by the Midwest, Northeast, and West.

Hypertension-related visits were also more common during winter months than summer months.

The cost of hospitalizations due to hypertension was $113 billion between 2003 and 2006, the researchers noted.

The researchers also found that more than 40% of the hypertension-related ER visits led to hospitalization.

“Compared with hypertension-related [emergency department (ED)] visits overall, ED visits with a primary diagnosis of hypertension occurred in patients who were overall younger, healthier, more likely to be uninsured, more likely to have an income in the lowest quartile, and less likely to be hospitalized after the ED visit,” the researchers stated. “This suggests that these patients may be using the ED as a source of primary care.”

Considering this heavy burden on emergency departments, retail clinicians can step up by encouraging patients to have their blood pressure checked.

Kristen Marjama, DNP, FNP-BC, manager of clinic education and development for Walmart Care Clinic, previously toldContemporary Clinicthat nurse practitioners and physician assistants working in retail clinics can identifypatients at risk, undiagnosed, or on a blood pressure medication but do not have their blood pressure controlled.

There are around 136.3 million general ER visits annually, and there is evidence of patients seeking ER care more frequently for chronic conditions and acute symptoms of chronic disease, according to the researchers.