An Evidence-Based Approach to Asymptomatic Hypertension in Urgent Care (Pharmacology CME)

Publication Date: December 2025 (Volume 4, Number 12)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 11/01/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for .25 Pharmacology CME credits, subject to your state and institutional approval.

Author

Melissa Orman, MD

Head of Operations, Orman Physician Coaching, Bend, OR

Peer Reviewer

Claude E. Shackelford, MD

Assistant Professor of Clinical Medicine, Vanderbilt University Medical Center; Assistant Medical Director, Walk-In Clinics, Vanderbilt University Medical Center, Nashville, TN

Abstract

Many patients presenting to urgent care are unaware of their hypertensive status, placing them at substantial risk for cardiovascular, renal, neurological, and ocular complications without appropriate recognition and follow-up. Urgent care clinicians must be prepared to address elevated blood pressure readings while also avoiding unnecessary emergency department referrals for patients who can be safely managed in the outpatient setting. This issue provides evidence-based guidance on the clinical approach to asymptomatic hypertension in adult patients in the urgent care setting, including differentiation of hypertensive emergency from poorly controlled hypertension. Current guidelines on acute care management of high blood pressure are reviewed, along with treatment, disposition, and follow-up recommendations.

Case Presentations

CASE 1

A 52-year-old woman is referred to UC by her primary care physician’s office for a blood pressure reading of 190/120 mm Hg...

She had been previously diagnosed with hypertension and had presented at the PCP office for her annual physical today.
When she arrives at UC, her blood pressure reading is 160/100 mm Hg.
She denies headache, chest pain, shortness of breath, or any vision changes. Her physical examination is normal.
She confesses that she has been poorly compliant with her hydrochlorothiazide.
You wonder what you should do for her…

CASE 2

A 35-year-old man presents to UC with a complaint of severe ankle pain…

His blood pressure is persistently elevated, with multiple readings of 220/110 mm Hg during the visit.
He has never been diagnosed with hypertension and his only complaint today is of severe pain in his ankle.
He shares that he has an unstable living situation and has had poor access to fluids recently.
Despite treatment with analgesics and alleviation of his pain, he remains significantly hypertensive.
You wonder if there is a secondary cause of his hypertension...

CASE 3

A 78-year-old woman is brought to UC by her family for a concern of new-onset hypertension…

She has no recent medical history and is not taking any medications.
She had her blood pressure checked at the pharmacy several times over the preceding weeks, and it was consistently around 150/90 mm Hg.
Her physical examination is normal. She does not have a primary care physician, and the earliest appointment the family has been able to schedule with an internist is in 3 weeks.
The family is appropriately concerned and asks if you could start her on medication, but you wonder if that is the best approach for this patient...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.