血压升高在急诊科很常见，但重要吗？一项纳入30278名成年人的回顾性队列研究
Elevated Blood Pressures Are Common in the Emergency Department but Are They Important? A Retrospective Cohort Study of 30,278 Adults
在急诊科常见的血压升高情况，很重要吗？一项纳入30278名成年人的回顾性队列研究
We determine the frequency of elevated blood pressure (BP) readings in the emergency department (ED), the proportion of patients with prior or subsequent diagnosis of hypertension assigned in other settings, and the association between ED BP levels and cardiovascular outcomes after ED discharge.
我们评估急诊科患者血压升高的频率,在其他医疗机构就诊前或后诊断为高血压的患者比例，以及急诊科血压水平与出院后心血管事件之间的相关性。
This was a retrospective cohort study using electronic medical records for all adults treated and released from a large-volume ED in 2016 that were linked to administrative records for all health care encounters in the province for 2 years before and after the index ED visit. The primary outcome measure was a composite of stroke or transient ischemic attack, acute coronary syndrome, new heart failure, or death.
这是一项回顾性队列研究，使用了2016年在某大型急诊科治疗并出院的所有成年患者的电子病历，电子病历与该省所有检索的急诊患者就诊及随访2年的医疗记录关联。主要结局是指中风或短暂性脑缺血发作、急性冠状动脉综合征、新发心衰、死亡的综合结局。
Of 30,278 adults treated and released from the ED, 14,717 (48.6%) had elevated BP readings; 10,732 (72.9%) had no prior diagnosis of hypertension. Of the 3,480 patients with no prior diagnosis of hypertension but an ED BP greater than or equal to 160/100 mm Hg, 907 (26.1%) subsequently received a diagnosis of chronic hypertension or were prescribed antihypertensive therapy in other settings within 2 years. Among patients without a history of hypertension, those with an ED BP greater than or equal to 160/100 mmHg were more likely to meet the composite outcome (stroke, transient ischemic attack, acute coronary syndrome, heart failure, or death) in the subsequent year (3.3% versus 2.5%) or 2 years (5.9% versus 3.8%) than those with ED BPs 120 to 139/80 to 89 mmHg; however, after adjusting for age, sex, diabetes, atrial fibrillation, and prior cardiovascular disease, their risk was not elevated (adjusted hazard ratio 0.84; 95% confidence interval 0.71 to 1.004 during 2 years).
在急诊科接受治疗并从急诊科出院的30278名成年人中，14,717名（48.6％）患者有血压升高，其中10,732（72.9％）名患者先前没有诊断出高血压。在3480名原先没有被诊断高血压，但就诊于急诊时 BP≥160/100 mmHg的患者中，有907名（26.1％）随后被诊断出患有慢性高血压或在2年内在其他医疗机构接受了抗高血压治疗。在没有高血压病史的患者中，急诊测BP≥160/100 mmHg的患者，相较于急诊血压为120-139/80-89 mmHg的患者，在其后1年（3.3％对2.5％）或2年（5.9％对3.8％）内更容易发生综合结局（中风、短暂性脑缺血发作、急性冠状动脉综合征、心力衰竭或死亡）。但是，在校正了年龄、性别、糖尿病、房颤、心血管疾病史后，其风险并未升高（2年内的校正后的危险比为0.84；95％置信区间为0.71-1.004）。
CONCLUSION
Elevated BP readings in the ED are common and are often the first time hypertension is detected; however, they were not associated with adverse cardiovascular outcomes within 2 years of the visit.
急诊患者的血压升高很常见，且通常是首次发现血压升高。然而，在随访的两年内，血压升高与心血管不良结果无相关性。
翻译：北京协和医院急诊科博士后 袁媛
审校：甜汁饺子