Scope of Application
This guideline is intended for physicians working in emergency departments.

Inclusion Criteria
This guideline is intended for patients aged 18 years or older who present to the ED with asymptomatic elevated blood pressure without signs and symptoms of acute target organ injury.

Exclusion Criteria
This guideline is not intended to address the care of patients who present to the ED with signs or symptoms of acute hypertensive emergencies (ie, patients with clinical findings that suggest acute target organ injuries such as acute stroke, cardiac ischemia, pulmonary edema, encephalopathy, and congestive heart failure), pregnant patients, those with end-stage renal insufficiency, emergent conditions that are likely to cause elevated blood pressure not directly related to acute target organ injury (eg, trauma, other pain syndromes), and acute presentations of serious medical conditions associated with hypertension such as stroke, myocardial infarction, and congestive heart failure.

Critical Questions

1. In ED patients with asymptomatic elevated blood pressure, does screening for target organ injury reduce rates of adverse outcomes?
   
   Level C Recommendations:
   
   (1) In ED patients with asymptomatic markedly elevated blood pressure, routine screening for acute target organ injury (eg, serum creatinine, urinalysis, ECG) is not required.
   
   (2) In select patient populations (eg, poor follow-up), screening for an elevated serum creatinine level may identify kidney injury that affects disposition (eg, hospital admission).
   
   
   
2. In patients with asymptomatic markedly elevated blood pressure, does ED medical intervention reduce rates of adverse outcomes?
   
   Level C Recommendations:
   
   (1) In patients with asymptomatic markedly elevated blood pressure, routine ED medical intervention is not required.
   
   (2) In select patient populations (eg, poor follow-up), emergency physicians may treat markedly elevated blood pressure in the ED and/or initiate therapy for long-term control. (Consensus recommendation)
   
   (3) Patients with asymptomatic markedly elevated blood pressure should be referred for outpatient follow-up. (Consensus recommendation)

Disclaimer
Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician's judgment and patient preferences.