What are the ACEP guidelines for ED treatment of hypertensive urgency?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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In the 2013, the American College of Emergency Physicians (ACEP) released an update of its 2006 guidelines for hypertension in the emergency department (ED), which are focused on treating hypertensive urgency. The recommendations include the following [140] :

  • In ED patients with asymptomatic markedly elevated blood pressure, routine screening for acute target organ injury (eg, serum creatinine, urinalysis, electrocardiogram [ECG]) is not required.
  • In select patient populations (eg, those with poor follow-up), screening for an elevated serum creatinine level may identify kidney injury that affects disposition (eg, hospital admission)
  • In patients with asymptomatic markedly elevated blood pressure, routine ED medical intervention is not required
  • In select patient populations (eg, poor follow-up available), emergency physicians may treat markedly elevated blood pressure in the ED and/or initiate therapy for long-term control (Consensus recommendation)
  • Patients with asymptomatic markedly elevated blood pressure should be referred for outpatient follow-up (Consensus recommendation)

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