Wake Forest University School of Medicine will use a $630,000 federal grant to establish the first hypertension registry prototype in the United States.
The Hypertension and Vascular Disease Center of Wake Forest University Baptist Medical Center and the departments of Emergency Medicine and Public Health Sciences will collaborate to develop this emergency-department-based registry.
All adult patients who visit the Medical Center’s emergency department will be screened for hypertension—high blood pressure—and referred for treatment, if necessary. Those diagnosed with hypertension will be contacted approximately 90 days after their visit to determine if they are complying with recommended treatment and if blood pressure has improved. The registry will document and track the magnitude of the problem, its relation to cardiovascular disease and stroke, and its impact on emergency department resources, according to David M. Cline, M.D., research director of the Department of Emergency Medicine.
"This pilot phase will establish the conditions, resources and mechanisms that could lead to the successful implementation of a statewide emergency department-based hypertension registry," said Cline.
The goals of the proposed registry are:
- To accurately assess for the first time the impact of high blood pressure on emergency departments and the populations they serve in terms of prevalence, clinical presentation and frequency of clinical events.
- Identify the tools and limitations that could either facilitate or handicap the development and implementation of a comparable system across North Carolina.
According to Carlos M. Ferrario, M.D., director of the Hypertension and Vascular Disease Center, the absence of a national surveillance system to measure the impact of hypertension, based on actual blood pressure measurements, has restricted public health initiatives aimed at reducing the impact of cardiovascular disease across the nation. "Registries are fundamental to efforts of identifying clusters, alerting communities to epidemics and setting up rapid response teams to address public health problems effectively," he said. "Establishing a hypertension registry based on individual risk factors promises broad-based success, since the incidence of multiple chronic disease conditions like heart attack, stroke, congestive heart failure and renal failure can be affected simultaneously."
Because underserved populations such as minorities and the poor often use emergency departments as their primary source of health care, a successful registry could contribute to the elimination of racial and ethnic disparities in the burden of hypertension-related disorders. At Wake Forest University Baptist Medical Center, of more than 60,000 emergency department visits annually, 45 percent are made by African-Americans and other minorities. Of all visits:
- 21 percent are admitted.
- 13 percent are Medicare patients.
- 24 percent are Medicaid patients.
- 76 percent are adults.
Previous studies have shown that, upon entry to the emergency department, 27 percent of adult patients report a history of hypertension and 36 percent report current usage of antihypertensive medications.
Hypertension is the leading cause of heart disease and stroke, which reflect mortality rates that are higher in the South than anywhere else in the nation.
Cline and Karen Sigmon Smith, MPH, RHEd, a research assistant with the Hypertension and Vascular Disease Center, will serve as the co-principal investigators. Ferrario and David C. Goff Jr., M.D., Ph.D., professor of Public Health Sciences-Epidemiology will serve as co-investigators.
The three-year grant was made possible through a cooperative agreement between the Centers for Disease Control and Prevention and the Association of Teachers of Preventive Medicine.
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