Title : Screening for causes of secondary hypertension on hospital admission.
Abstract:
Introduction: Although majority of patients have essential hypertension, secondary hypertension can also cause significant cardiovascular events. Secondary hypertension is defined as hypertension due to an identifiable cause and has a prevalence of 5-10%. European Society of Cardiology (ESC) have clear guidelines on screening for causes of secondary hypertension.1 However, many patients presenting with high blood pressure are not screened, based on the ESC screening criteria, for secondary causes of hypertension as part of their initial assessment on hospital admission.2 There is limited evidence in the literature for the impact of screening for secondary causes of hypertension on patient outcomes during hospital admission. We aimed to investigate the effect of ESC guideline-based interventions on screening for secondary hypertension and the impact on outcomes for patients in hospital.
Methods: We looked at the hospital data of patients between January 2023- May 2023 with a presenting symptom of hypertension in a district general hospital in London. We identified that several patients who were eligible for screening based on the ESC screening guidelines were not being screened for secondary. 1 We collected data in two cycles, after each intervention. The first intervention to improve screening on admission for secondary hypertension was to organise a teaching session for the Accident and Emergency department (A&E) and the Acute Medical unit (AMU); this was delivered in early March, data was collected pre and post the intervention between March 2023 to mid- April 2023. In late April 2023, we introduced the second intervention which was a poster with ESC screening criteria as well as referral pathway for admitting clinicians to refer to when assessing patients (See Figure 1). The poster was presented and placed in the doctor’s office in A&E and AMU, data was collected pre and post the intervention between late April 2023 to late-May 2023. Data collected was quantitative. Significance was detected by a paired t-test for each intervention, p <0.05.
Results: We found that between 1st January to 28th February 2023, 18% patients presenting with hypertension were eligible for screening based on ESC guidelines, out of which, 15% were screened (Figure 2). Most patients had a screening indication of acute worsening hypertension with previously documented chronically stable normotension. Post the teaching session, there was an increase in patients being screened for secondary hypertension (18 % vs 19%, pre-teaching vs post-teaching, p= 0.07) (See figure 3). After our second intervention, we found a statistically significant improvement in the number of patients screened for secondary hypertension (19% vs 27%, pre-poster presentation vs post-poster presentation, p=0.008) ( figure 4). On follow up of the patients who were screened early in admission, we found that it led to initiation of early management, better control of their hypertension and medically improved outcomes.
Conclusion: Screening for secondary hypertension is vital for improving outcomes for patients in hospital as it allows early initiation of management. Raising awareness of the screening criteria by local hospital-based interventions is key to identifying patients with secondary hypertension, allowing early management and control of the underlying condition. long term benefits of screening could prove to be more cost effective as patient’s will be less likely to present to hospital with adverse consequences of the causes of secondary hypertension such as end organ damage, stroke and sudden cardiac death.
Audience Take Away Notes
- The audience will be able to learn the importance of screening for secondary hypertension on admission and their impact on patient care during their hospital stay.
- The audience will be able to appreciate how simple local measures to increase awareness of screening criteria can improve patient outcomes.
- Screening for hypertension will allow early management of the causes of hypertension, improving patient care and reduce the risk of patients being readmitted with end organ damage, strokes and myocardial infarction.
- Screening for secondary causes of hypertension will allow clinicians to modify a patients cardiovascular
- Further research is required to assess the impact of hospital-based interventions to increase screening for secondary hypertension on admission and its long-term benefits and effects on patient morbidity and mortality.
