Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department With Asymptomatic Elevated Blood Pressure

Official 2013 guideline from the American College of Emergency Physicians.

Strength

Risk Stratification and Intervention

Risk Stratification

Level C

In emergency department (ED) patients with asymptomatic markedly elevated blood pressure, routine screening for acute target organ injury (eg, serum creatinine, urinalysis, electrocardiogram [ECG]) is not required.

Level C

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).

Intervention

Level C

In patients with asymptomatic markedly elevated blood pressure, routine emergency department (ED) medical intervention is not required.

Level C

In select patient populations (eg, poor follow-up), emergency physicians may treat markedly elevated blood pressure in the emergency department (ED) and/or initiate therapy for long-term control. [Consensus recommendation]

Level C

Patients with asymptomatic markedly elevated blood pressure should be referred for outpatient follow-up. [Consensus recommendation]

Literature

Original/Primary Reference

Wolf SJ, Lo B, Shih RD, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department With Asymptomatic Elevated Blood Pressure. Ann Emerg Med. 2013;62(1):5

Summary By

Eric Steinberg, DO, MEHP

What do the ratings mean?

Level A

Generally accepted principles for patient management that reflect a high degree of clinical certainty (ie, based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues).

Level B

Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (ie, based on strength of evidence Class II studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of strength of evidence Class III studies).

Level C

Other strategies for patient management that are based on Class III studies or, in the absence of any adequate published literature, based on panel consensus. In instances in which consensus recommendations are made, this is specifically indicated next to the recommendation.