Elevated Blood Pressure Among Military Emergency Department Patients

Hypertension is a leading modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) resulting in a significant burden on public health. Although the relationship between elevated blood pressure (BP) and long-term ASCVD risk is well-established in older adults, data for younger populations, such as military service members and athletes, remain limited. To assess early detection of hypertension, this study describes the prevalence of elevated BP in emergency departments (EDs) and its relationship with subsequent diagnoses of hypertension. A retrospective analysis was conducted using out-patient medical encounters involving active duty U.S. Armed Forces service members between January 2016 and December 2022 (N = 58,426). Sociodemographic and occupational data were obtained from administrative records and electronic health records provided medical data. Multivariable mixed-effects regression analysis was used to assess the relationship between patient characteristics and BP. The prevalence of hypertension for our sample population presenting to military EDs was 37.9%, though only 3.4% had a prior diagnosis of hypertension. At the time of the ED visit, 30.2% of patients met the criteria for Stage 1 hypertension. During follow-up over the next 12 months, 41.7% remained at Stage 1 or Stage 2 hypertension, with the diagnosis of hypertension rising from 2.5% to 5.7%. Additionally, 7.7% of patients met the criteria for Stage 2 hypertension at the time of the ED visit. In follow-up, 68.7% remained at Stage 1 or 2 hypertension, while the diagnosis of hypertension increased from 8.2% to 16.7%. Elevated BP in military EDs is prevalent among active duty service members and is associated with an increased likelihood of future hypertension readings; however, the diagnosis of hypertension is lower than expected. These findings suggest that elevated BP in EDs should prompt outpatient follow-up for hypertension evaluation, facilitating early intervention and reducing long-term ASCVD risk.