Eunhee Choi

BACKGROUND: Home blood pressure (BP) monitoring over a 7-day period is recommended to confirm the diagnosis of hypertension. METHODS: We determined upper and lower home BP thresholds with >90% positive predictive value and >90% negative predictive value using 1 to 6 days of monitoring to identify high home BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg) based on 7 days of home BP monitoring. The sample included 361 adults from the Improving the Detection of Hypertension Study who were not taking antihypertensive medication. We used two 7-day periods, at least 3 days apart, the first being a sampling period and the second a reference period. For each number of days in the sampling period, we determined the percentage of participants who had a high likelihood of having (>90% positive predictive value) or not having (>90% negative predictive value) high BP and would not need to continue home BP monitoring. Only the participants in an uncertain category (ie, positive predictive value ≤90% and negative predictive value ≤90%) after each day were carried forward to the next day of home BP monitoring. RESULTS: Of the 361 participants (mean [SD] age of 41.3 [13.2] years; 60.4% women), 38.0% had high home BP during the reference period. There were 63.7%, 17.1%, 10.5%, 3.3%, 3.6%, and 1.4% participants who would not need to continue after 1, 2, 3, 4, 5, and 6 days of monitoring. CONCLUSIONS: In most people, high home BP can be identified or excluded with a high degree of confidence with 3 days or less of monitoring.

Background To study the prevalence and types of hypertension‐mediated organ damage and the prognosis of patients presenting to the emergency department (ED) with hypertensive emergencies. Methods and Results PubMed was queried from inception through November 30, 2021. Studies were included if they reported the prevalence or prognosis of hypertensive emergencies in patients presenting to the ED. Studies reporting data on hypertensive emergencies in other departments were excluded. The extracted data were arcsine transformed and pooled using a random‐effects model. Fifteen studies (n=4370 patients) were included. Pooled analysis demonstrates that the prevalence of hypertensive emergencies was 0.5% (95% CI, 0.40%–0.70%) in all patients presenting to ED and 35.9% (95% CI, 26.7%–45.5%) among patients presenting in ED with hypertensive crisis. Ischemic stroke (28.1% [95% CI, 18.7%–38.6%]) was the most prevalent hypertension‐mediated organ damage, followed by pulmonary edema/acute heart failure (24.1% [95% CI, 19.0%–29.7%]), hemorrhagic stroke (14.6% [95% CI, 9.9%–20.0%]), acute coronary syndrome (10.8% [95% CI, 7.3%–14.8%]), renal failure (8.0% [95% CI, 2.9%–15.5%]), subarachnoid hemorrhage (6.9% [95% CI, 3.9%–10.7%]), encephalopathy (6.1% [95% CI, 1.9%–12.4%]), and the least prevalent was aortic dissection (1.8% [95% CI, 1.1%–2.8%]). Prevalence of in‐hospital mortality among patients with hypertensive emergency was 9.9% (95% CI, 1.4%–24.6%). Conclusions Our findings demonstrate a pattern of hypertension‐mediated organ damage primarily affecting the brain and heart, substantial cardiovascular renal morbidity and mortality, as well as subsequent hospitalization in patients with hypertensive emergencies presenting to the ED.