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.