Treatment of Asymptomatic Severe Hypertension in the Emergency Department

Severely elevated blood pressure (greater than 180/110 mmHg) is a common finding encountered in the emergency department. This blood pressure level has traditionally been categorized as hypertensive urgency when there is no target organ damage or a hypertensive emergency when target organ damage is present. Asymptomatic severely elevated blood pressure is the preferred term instead of hypertensive urgency, as it does not imply a crisis exists. The assessment and management of patients with elevated blood pressure has been extensively studied in the primary care environment. However, most of the guidelines are not for patients with acute illness. Current guidelines are being challenged as not being evidence-based, impractical, and cost-inefficient when applied in the emergency department setting (D. J. Karras et al., 2006). There is general consensus that if treatment is initiated, with an aim to gradually lower the blood pressure level over 24 to 48 hr, then no attempt should be made to rapidly lower it.