Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Asymptomatic Hypertension in the ED: What’s the Urgency?

Phillip Levy, MD, MPH

Wayne State, Department of Emergency Medicine

  • Emergency department patients are more than twice as likely (16.3% vs. 6.8%) to have severely elevated BP than individuals seen in the primary care setting. Niska R. NCHS Data Brief. 2011;72.
  • Despite the relative frequency of severe BP elevations, there is no consensus on how to approach such patients absent overt evidence of target organ damage. Shayne and Pitts. Ann Emerg Med. 2003;41:513-29.
  • For patients with asymptomatic BP elevations, the focus of ED management should be on identification of true hypertension, referral to outpatient follow-up, disease-specific education, and, for some initiation of chronic antihypertensive therapy - achievement of BP "cosmesis" is unnecessary and potentially detrimental. Decker et al. Ann Emerg Med 2006;47:237-49
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