[Severe hypertension in primary care or emergency departments: avoid unnecessary referrals or additional diagnostics]

Severe hypertension is a common reason to visit the General Practitioner (GP) or Emergency Department (ED) and accounts for 1-2% of all ED visits in the Netherlands. In 2021 a new national guideline 'Hypertensive emergency' was developed. In practice, however, a large variability with regards to referrals and additional diagnostics still exists. Here, we present three exemplary cases presenting to the GP or ED with severe hypertension. Based on the current guideline, we suggest that initial presenting complaints should guide the physician's choice for referral and additional diagnostics instead of the blood pressure reading. Patients with a high blood pressure and symptoms pointing towards acute hypertensive organ damage (e.g., chest pain, acute dyspnea) should always be referred to the ED, while. patients with headache or visual disturbances alone should only be referred if the blood pressure exceeds 200/120 mmHg.