Blood Pressure and Medication Adherence Among Patients in the Emergency Department

Abstract

Hypertension is one of the most important modifiable risk factors for stroke, cardiovascular disease, and renal failure, and it affects more than 30% of all adult Americans. The prevalence of hypertension is increasing, as is the proportion of Americans who seek care in the emergency department (ED). Despite the growing importance of ED care in management of chronic conditions such as hypertension, the relationship between ED and post-ED BP is not well understood, nor is the contribution of medication non-adherence to elevated BP among patients who seek ED care. This dissertation addresses these evidence gaps by 1) examining the relationship between ED BP and follow up BP within the subsequent year among patients with a single Adult ED visit, 2) evaluating test characteristics of a mass spectrometry blood assay that detects 19 antihypertensive medications as a direct measure of antihypertensive adherence, comparing the assay to previously validated medication adherence measures in two patient populations, and 3) determining the relationship between medication adherence and systolic BP to determine the predictive validity of the assay as a measure of antihypertensive adherence.