1. “I aggressively treat all patients with elevated blood pressure initially, and then decide who needs to be admitted or discharged based on their response to therapy.”
It is wise to tailor diagnostic and management strategies to the individual patient and to distinguish patients with asymptomatic elevated blood pressure from those presenting with symptoms that are suggestive of end-organ damage or hypertensive emergency. While the former need a blood pressure recheck in days to weeks, the latter may need parenteral therapy and admission (frequently to the intensive care unit setting). Also, blood pressure that is elevated on initial triage measure may decrease without an intervention on recheck. While patients with asymptomatic elevation of blood pressure have a low likelihood of shortterm decompensation, those with hypertensive emergency need parenteral therapy to prevent potentially fatal acute end-organ damage.107
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