Abstract

In this issue EM Practice Guidelines Update, 2 practice guidelines that address the management of hypertension in the emergency department (ED) are reviewed. The recommendations within these guidelines focus on specific patient presentations, from the asymptomatic patient with an elevated blood pressure to the patient with a specific diagnosis and possible end-organ damage. According to the United States Centers for Disease Control and Prevention, 32.6% of adults 20 years of age or older have hypertension, which is defined as blood pressure of > 160 mm Hg systolic, and > 100 mm Hg diastolic.¹

While elevated blood pressure is commonly encountered in the ED, evidence does not support the use of pharmacologic agents to lower blood pressure in the ED except in a small subset of patients. This issue of EM Practice Guidelines Update will help define the areas where blood pressure treatment in the ED may be warranted.

Practice Guideline Impact

• ED personnel should measure blood pressure using accepted techniques that include an appropriate-sized cuff.
• Routine ED treatment of elevated blood pressure and routine laboratory or imaging studies in asymptomatic patients is not warranted in the vast majority of cases.
• Different clinical presentations of elevated blood pressure in the ED warrant different management strategies.

Keywords: Hypertension, asymptomatic hypertension, high blood pressure, hypertension guidelines