acep mobile

Blood Pressure (Asymptomatic, Elevated – Adult)

Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department With Asymptomatic Elevated Blood Pressure (February 2013)

Complete Clinical Policy on Asymptomatic Elevated Blood Pressure

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 injury 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 A recommendations. None specified.

Level B recommendations. None specified.

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 A recommendations. None specified.

Level B recommendations. None specified.

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]

Purpose of ACEP’s Clinical Policies

Clinical Findings and Strength of Recommendations