Öz
Amaç: İstanbul ilindeki Acil Tıp asistanlarının, acil servise başvuran asemptomatik tansiyon yüksekliği olan hastalara yaklaşımlarının
değerlendirilmesidir.
Gereç ve Yöntem: 15 Şubat-15 Temmuz 2015 tarihleri arasında İstanbul ilindeki eğitim ve araştırma hastaneleri ve üniversite
hastanelerindeki Acil Tıp kliniklerinde, Acil Tıp asistanı olarak çalışan 211 hekime anket çalışması yapılmıştır.
Bulgular: Asistanların % 31.3’ü (n=66) asemptomatik tansiyon yüksekliğinde tedaviye başlayacağını ifade ederken, % 68.7’si (n=145)
herhangi bir tedavi uygulamadıklarını ifade etmiştir. Tedaviye başlayacağını ifade edenlerin; tedaviye başlama sınırları sistolik kan
basıncı için 130 ile 200 mm-Hg arasında, diyastolik kan basıncı için 80 ile 120 mm-Hg arasında, ortalama arter basıncı için ise 70 ile
150 mm-Hg arasında değişmektedir. Asistanların % 56.4’ü (n=119) asemptomatik tansiyon yüksekliği ile gelen hastalarda tetkik isteme
eğilimindeyken, % 43.6’sı (n=92) tetkik istemeyeceğini ifade etmişlerdir. Tetkik isteyeceğini ifade edenlerin % 29.4’ü (n=35)
Hemogram, % 79.0’u (n=94) böbrek fonksiyon testleri, karaciğer fonksiyon testleri, % 90.8’i (n=108) elektrokardiyografi, % 31.1’i
(n=37) kardiyak markırlar, % 2.6’sı (n=15) ise beyin BT isteyeceğini ifade etmiştir.
Sonuç: Asemptomatik tansiyon yüksekliği gibi tedavi ve takibi arada konuların standart ve doğru bir yaklaşım ile yönetilebilmesi için,
bu konuyla ilgili eğitimlerin özellikle ilk yıllarda verilmesinin, asistanların yaklaşımlarını değiştirmekte önemli olacağını düşünmekteyiz.
Anahtar Kelimeler
Kaynakça
- Adebayo, O., & Rogers, R. L. (2015). Hypertensive Emergencies in the Emergency Department. Emergency medicine clinics of North America, 33(3), 539–551. https://doi.org/10.1016/j.emc.2015.04.005
- Boal, A. H., Smith, D. J., McCallum, L., et al. (2016). Monotherapy With Major Antihypertensive Drug Classes and Risk of Hospital Admissions for Mood Disorders. Hypertension (Dallas, Tex. : 1979), 68(5), 1132–1138. https://doi.org/10.1161/HYPERTENSIONAHA.116.08188
- Chan, S. S., Graham, C. A., & Rainer, T. H. (2016). Hypertension in the Emergency Department. Current hypertension reports, 18(5), 37. https://doi.org/10.1007/s11906-016-0647-4
- Eshah, N. F., & Al-Daken, L. I. (2016). Assessing Public's Knowledge About Hypertension in a Community-Dwelling Sample. The Journal of cardiovascular nursing, 31(2), 158–165. https://doi.org/10.1097/JCN.0000000000000227
- Karras, D. J., Kruus, L. K., Cienki, J. Jet al. (2008). Utility of routine testing for patients with asymptomatic severe blood pressure elevation in the emergency department. Annals of emergency medicine, 51(3), 231–239. https://doi.org/10.1016/j.annemergmed.2007.03.032.
- Kessler, C. S., & Joudeh, Y. (2010). Evaluation and treatment of severe asymptomatic hypertension. American family physician, 81(4), 470–476.
- Ku, E., Lee, B. J., Wei, J., et al. (2019). Hypertension in CKD: Core Curriculum 2019. American journal of kidney diseases : the official journal of the National Kidney Foundation, 74(1), 120–131. https://doi.org/10.1053/j.ajkd.2018.12.044
- Laurent S. (2017). Antihypertensive drugs. Pharmacological research, 124, 116–125. https://doi.org/10.1016/j.phrs.2017.07.026
- Lee, S., Hess, E. P., Nestler, D. M., et al. (2013). Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis. The Journal of allergy and clinical immunology, 131(4), 1103–1108. https://doi.org/10.1016/j.jaci.2013.01.011
- Mills, K. T., Bundy, J. D., Kelly, T. N., et al. (2016). Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation, 134(6), 441–450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912
- Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature reviews. Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2
- Pierin, A., Flórido, C. F., & Santos, J. D. (2019). Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department. Einstein (Sao Paulo, Brazil), 17(4), eAO4685. https://doi.org/10.31744/einstein_journal/2019AO4685
- Shao, P. J., Sawe, H. R., Murray, B. L., et al. 2018). Profile of patients with hypertensive urgency and emergency presenting to an urban emergency department of a tertiary referral hospital in Tanzania. BMC cardiovascular disorders, 18(1), 158. https://doi.org/10.1186/s12872-018-0895-0
- Şengul, S., Akpolat, T., Erdem, Y., et al. (2016). Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. Journal of hypertension, 34(6), 1208–1217. https://doi.org/10.1097/HJH.0000000000000901
- Vondracek, S., Scoular, S., & Patel, T. (2016). Management of severe asymptomatic hypertension in the hospitalized patient. Journal of the American Society of Hypertension : JASH, 10(12), 974–984. https://doi.org/10.1016/j.jash.2016.10.008
- Williams, B., Mancia, G., Spiering, W., et al. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Journal of hypertension, 36(10), 1953–2041. https://doi.org/10.1097/HJH.0000000000001940
- Wolf, S. J., Lo, B., Shih, R., et al. & American College of Emergency Physicians Clinical Policies Committee (2013). Clinical policy: critical issues in the evaluation and management of adult patients in the emergency department with asymptomatic elevated blood pressure. Annals of emergency medicine, 62(1), 59–68. https://doi.org/10.1016/j.annemergmed.2013.05.012
- Yurekli, A. A., Bilir, N., & Husain, M. J. (2019). Projecting burden of hypertension and its management in Turkey, 2015-2030. PloS one, 14(9), e0221556. https://doi.org/10.1371/journal.pone.0221556
Öz
Purpose: It is the evaluation of the approach of the Emergency Medicine assistants in the city of Istanbul to patients with asymptomatic hypertension admitted to the emergency department.
Material and Methods: A survey was conducted on 211 physicians working as emergency medical assistants in training and research hospitals and emergency medicine clinics in university hospitals in Istanbul between February 15 and July 15, 2015.
Results: While 31.3% (n = 66) of the residents stated that they would start treatment in asymptomatic high blood pressure, 68.7% (n = 145) stated that they did not apply any treatment. For those who stated that they would start treatment; The limits of initiation of therapy ranged from 130 to 200 mm-Hg for systolic blood pressure, 80 to 120 mm-Hg for diastolic blood pressure, and 70 to 150 mm-Hg for mean arterial pressure. While 56.4% (n = 119) of the residents tended to request examination in patients presenting with asymptomatic high blood pressure, 43.6% (n = 92) stated that they would not want the test. 29.4% (n = 35) of those who stated that they would want to have a test, hemogram, 79.0% (n = 94) kidney function tests, liver function tests, 90.8% (n = 108) electrocardiography, 31.1% (n = 37) cardiac markers, 2.6% (n = 15) stated that they would require brain CT.
Conclusion: We think that training on this subject, especially in the first years, will be important in changing the approaches of residents in order to manage issues such as asymptomatic high blood pressure with a standard and correct approach.
Anahtar Kelimeler
Emergency clinic Asymptomatic hypertension Emergency medicine assistants
Kaynakça
- Adebayo, O., & Rogers, R. L. (2015). Hypertensive Emergencies in the Emergency Department. Emergency medicine clinics of North America, 33(3), 539–551. https://doi.org/10.1016/j.emc.2015.04.005
- Boal, A. H., Smith, D. J., McCallum, L., et al. (2016). Monotherapy With Major Antihypertensive Drug Classes and Risk of Hospital Admissions for Mood Disorders. Hypertension (Dallas, Tex. : 1979), 68(5), 1132–1138. https://doi.org/10.1161/HYPERTENSIONAHA.116.08188
- Chan, S. S., Graham, C. A., & Rainer, T. H. (2016). Hypertension in the Emergency Department. Current hypertension reports, 18(5), 37. https://doi.org/10.1007/s11906-016-0647-4
- Eshah, N. F., & Al-Daken, L. I. (2016). Assessing Public's Knowledge About Hypertension in a Community-Dwelling Sample. The Journal of cardiovascular nursing, 31(2), 158–165. https://doi.org/10.1097/JCN.0000000000000227
- Karras, D. J., Kruus, L. K., Cienki, J. Jet al. (2008). Utility of routine testing for patients with asymptomatic severe blood pressure elevation in the emergency department. Annals of emergency medicine, 51(3), 231–239. https://doi.org/10.1016/j.annemergmed.2007.03.032.
- Kessler, C. S., & Joudeh, Y. (2010). Evaluation and treatment of severe asymptomatic hypertension. American family physician, 81(4), 470–476.
- Ku, E., Lee, B. J., Wei, J., et al. (2019). Hypertension in CKD: Core Curriculum 2019. American journal of kidney diseases : the official journal of the National Kidney Foundation, 74(1), 120–131. https://doi.org/10.1053/j.ajkd.2018.12.044
- Laurent S. (2017). Antihypertensive drugs. Pharmacological research, 124, 116–125. https://doi.org/10.1016/j.phrs.2017.07.026
- Lee, S., Hess, E. P., Nestler, D. M., et al. (2013). Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis. The Journal of allergy and clinical immunology, 131(4), 1103–1108. https://doi.org/10.1016/j.jaci.2013.01.011
- Mills, K. T., Bundy, J. D., Kelly, T. N., et al. (2016). Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation, 134(6), 441–450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912
- Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature reviews. Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2
- Pierin, A., Flórido, C. F., & Santos, J. D. (2019). Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department. Einstein (Sao Paulo, Brazil), 17(4), eAO4685. https://doi.org/10.31744/einstein_journal/2019AO4685
- Shao, P. J., Sawe, H. R., Murray, B. L., et al. 2018). Profile of patients with hypertensive urgency and emergency presenting to an urban emergency department of a tertiary referral hospital in Tanzania. BMC cardiovascular disorders, 18(1), 158. https://doi.org/10.1186/s12872-018-0895-0
- Şengul, S., Akpolat, T., Erdem, Y., et al. (2016). Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. Journal of hypertension, 34(6), 1208–1217. https://doi.org/10.1097/HJH.0000000000000901
- Vondracek, S., Scoular, S., & Patel, T. (2016). Management of severe asymptomatic hypertension in the hospitalized patient. Journal of the American Society of Hypertension : JASH, 10(12), 974–984. https://doi.org/10.1016/j.jash.2016.10.008
- Williams, B., Mancia, G., Spiering, W., et al. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Journal of hypertension, 36(10), 1953–2041. https://doi.org/10.1097/HJH.0000000000001940
- Wolf, S. J., Lo, B., Shih, R., et al. & American College of Emergency Physicians Clinical Policies Committee (2013). Clinical policy: critical issues in the evaluation and management of adult patients in the emergency department with asymptomatic elevated blood pressure. Annals of emergency medicine, 62(1), 59–68. https://doi.org/10.1016/j.annemergmed.2013.05.012
- Yurekli, A. A., Bilir, N., & Husain, M. J. (2019). Projecting burden of hypertension and its management in Turkey, 2015-2030. PloS one, 14(9), e0221556. https://doi.org/10.1371/journal.pone.0221556
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Mayıs 2021 |
| Gönderilme Tarihi | 8 Mart 2021 |
| Kabul Tarihi | 27 Nisan 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 2 Sayı: 2 |
Cited By
Turkish Journal of Science and Health (TFSD)
E-mail: tfsdjournal@gmail.com
Bu eser Creative Commons Alıntı-GayriTicari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.