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Updated: Aug 27, 2026

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Emergency department blood pressure elevations frequently occur without documented hypertension diagnosis
Diane Kuhn1,2, Paul I Musey1,2, Katherine A Pollard1
1Department of Emergency Medicine, Indiana University School of Medicine.
Background:
High blood pressure readings (HBPRs) are common in emergency department (ED) patients, but the frequency of HBPRs among patients without a documented diagnosis of hypertension (DDxHTN) is unclear.
Methods:
We performed a retrospective study of discharged ED encounters at a large Midwestern academic ED in 2024. HBPRs were defined as blood pressure ≥130 mmHg systolic or ≥80 mmHg diastolic.
Results:
Among 66 624 discharged encounters with blood pressure data, 52 461 (78.7%) had at least one HBPR and 38 715 (58.1%) had at least one Stage 2-range HBPR (≥140/90 mmHg). Among patients with Stage 2-range HBPRs, 22 471 (58.0%) lacked DDxHTN. Older age, female sex, Black race, absence of interpreter need, and Medicare or Medicaid coverage were independently associated with DDxHTN.
Conclusions:
More than half of discharged ED patients with Stage 2-range HBPRs lacked DDxHTN, and many had only a single documented blood pressure. The ED may provide an opportunity for blood pressure reassessment and outpatient referral.
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