Clinical Policy: Critical Issues in the Evaluation and Management
of Adult Patients With Asymptomatic Hypertension in the
Emergency Department
September 23, 2005

Normal <120 and <80

Prehypertension 120-139 or 80-89: lifestyle changes

Stage 1 hypertension 140-159 or 90-99: start single drug

Stage 2 hypertension >=160 or >=100: start 2 drugs

The table provides a classification of blood pressure for adults aged 18 years or older. The classification is based on the average of 2 or more properly
measured, seated blood pressure readings on each of 2 or more office visits.

1. Are ED blood pressure readings accurate and reliable for
screening asymptomatic patients for hypertension?

Level B recommendations. If blood pressure measurements
are persistently elevated with a systolic blood pressure greater
than 140 mm Hg or diastolic blood pressure greater than 90
mm Hg, the patient should be referred for follow-up of possible
hypertension and blood pressure management.

Level C recommendations. Patients with a single elevated
blood pressure reading may require further screening for
hypertension in the outpatient setting.

2. Patient Management Recommendations: Do
asymptomatic patients with elevated blood pressures benefit
from rapid lowering of their blood pressure?

Level B recommendations.
1. Initiating treatment for asymptomatic hypertension in
the ED is not necessary when patients have follow-up.
2. Rapidly lowering blood pressure in asymptomatic patients
in the ED is unnecessary and may be harmful in
some patients.
3. When ED treatment for asymptomatic hypertension is
initiated, blood pressure management should attempt to
gradually lower blood pressure and should not be expected
to be normalized during the initial ED visit.