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• Rural Poor!
  Alex F Hieatt
  Published on: 21 September 2005
• Screening for hypertension in the ED
  Simon M Smith
  Published on: 6 September 2005

• Published on: 21 September 2005

  Rural Poor!

  • Alex F Hieatt, Specialist Registrar Emergency Medicine

  Dear Editor Fleming et al. state in their article that this may be effective in detecting hypertension in the urban poor for whom the Emergency department is their sole source of freely avaliable healthcare. Is it then likely that these individuals are going to be effectively managed seeing as they seek Medical advice on such an adhock basis? Will they comply with their treatment and who is going to monitor it? Is it now...

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  Dear Editor Fleming et al. state in their article that this may be effective in detecting hypertension in the urban poor for whom the Emergency department is their sole source of freely avaliable healthcare. Is it then likely that these individuals are going to be effectively managed seeing as they seek Medical advice on such an adhock basis? Will they comply with their treatment and who is going to monitor it? Is it now the job of Emergency Physicians to take on another General practice role? Clearly this artcle is only relevant to a very specific population surrounding a big teaching hospital in an ethnically diverse metropolis and further studies will have to be done as to it's relevance for the population surrounding a DGH in rural Suffolk!

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  Conflict of Interest:
  None declared.

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• Published on: 6 September 2005

  Screening for hypertension in the ED

  • Simon M Smith, Consultant in Emergency Medicine

  Dear Editor,

  I read with interest the paper by Fleming et al.[1], concerning screening for hypertension in the Emergency Department. The significant Public Health issues and current emphasis on screening are well illustrated in this paper.

  However, there is increasing debate concerning the appropriateness of routine enquiry, as debated in the commentary by Lee.[2] If screening for a condition is warranted...

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  Dear Editor,

  I read with interest the paper by Fleming et al.[1], concerning screening for hypertension in the Emergency Department. The significant Public Health issues and current emphasis on screening are well illustrated in this paper.

  However, there is increasing debate concerning the appropriateness of routine enquiry, as debated in the commentary by Lee.[2] If screening for a condition is warranted it should, at least approximately, fulfil the Wilson Criteria.[3] The diagnosis of hypertension fails to meet these criteria in a number of important regards.

  Firstly, the end point of screening is to establish the diagnosis in order that prevention of an adverse end point is achieved on a population basis. In this paper only 2.5% of patients’ General Practitioners were directly informed of the diagnosis, and there is no data on the clinical results for these patients. The screening has become an end (to achieve diagnosis) not a means.

  Secondly systematic testing of a population for hypertension should be performed on a continuous and total basis, and this paper[1] reveals that this is difficult to achieve.

  Lastly, the case-finding needs to be economically balanced in relation to diagnosis and treatment and possible total health care expenditure, and this is not discussed.

  While universal screening for hypertension in the Emergency department may not be appropriate for the reasons above, or desirable for reasons related to service configuration, targeted screening for an essentially asymptomatic disease will fail almost be definition. This is not to say, however, that opportunistic detection in the Emergency department is not appropriate.

  Yours faithfully,

  Simon Smith
  Consultant in A&E

  References

  1. Fleming J, Meredith C, Henry J. Ddetection of hypertension in the emergency department. Emerg Med J 2005; 22: 636-9.

  2. Lee J. Should emergency departemtns really be screening fro hypertension? Emerg Med J 2005; 22: 640.

  3. Wilson JMG, Junger G. Principles and practice of screening for disease. Geneva: World Health Organisation, 1968. (Public health papers No 34).

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  Conflict of Interest:
  None declared.

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