New ACEP Clinical Guidelines: Adult Patients in the ED With Asymptomatic Elevated Blood Pressure

Check out the latest revision of the ACEP Clinical Guidelines on the Evaluation and Management of Adult Patients in the Emergency Department With Asymptomatic Elevated Blood Pressure:

http://www.acep.org/clinicalpolicies/

Bottom line — no good evidence on the topic!!!

So stop checking labs, urines, and ECG’s!  Discharge the patient with primary care followup.

 

The two questions addressed in this revision:

In ED patients with asymptomatic elevated blood pressure, does screening for target organ injury reduce rates of adverse outcomes?

Patient Management Recommendations

  • 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 may 
identify kidney injury that affects disposition (eg, hospital admission).

In patients with asymptomatic markedly elevated blood pressure, does ED medical intervention reduce rates of adverse outcomes?

Patient Management Recommendations

  • 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]
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