One or a combination of the listed medications is often used for blood pressure reduction in patients who present to the emergency department with acutely elevated blood pressure. Historically, many patients with asymptomatic hypertension – that is, elevated blood pressures without any evidence of end organ involvement (“hypertensive urgency”) – have also been treated with such antihypertensive agents in the ED.

The evaluation for end organ ischemia and appropriate referral for subsequent care occurs in a minority of patients with elevated blood pressure in most EDs.^19,20 This is particularly unfortunate given that it is unnecessary to treat the blood pressure of such patients in an emergency department setting, and doing so may actually increase the risk of adverse events.^7,21

Summary

The general approach to treating hypertensive emergencies entails a rapid, controlled reduction of blood pressure. As in a few of the cases discussed, it is occasionally necessary for emergency physicians to rapidly reduce a patient’s blood pressure even beyond the general recommendation of a 25% drop in mean arterial pressure.

Focused treatment of patients suffering from specific hypertensive emergencies should follow the guidelines and recommendations pertinent to their particular diagnosis. The emergency physician must take care to not undertake overaggressive treatment of simple blood pressure elevations without any evidence of target-organ damage.

Provided adequate follow-up, most patients who have elevated blood pressure in the emergency department can be safely discharged home without any intervention for their blood pressure. If the emergency physician is to intervene, initiation of treatment with an appropriate oral antihypertensive to gradually reduce the patient’s blood pressure over 24-48 hours and securing prompt outpatient follow-up for further management of hypertension is the recommended approach, as it allows for appropriate management while avoiding unintended side effects.

Contributor Disclosures

After reading this article, the physician should be able to:

Contributors
Dr. Phull is a fourth-year emergency medicine resident at Northwestern Memorial Hospital, Chicago. Dr. Aldeen is an Assistant Professor in the Department of Emergency Medicine at Northwestern University Feinberg School of Medicine, Chicago, and Director of the Chicago Cardiac Arrest Resuscitation Education Service. Dr. Robert Solomon is Medical Editor of ACEP News and editor of the Focus On series, core faculty in the emergency medicine residency at Allegheny General Hospital, Pittsburgh, and Assistant Professor in the Department of Emergency Medicine at Temple University School of Medicine, Philadelphia.

Disclosures
Dr. Phull, Dr. Aldeen, and Dr. Solomon have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this article.