Nonemergent hypertension. New perspectives for the emergency medicine physician

The emergency medicine physician must evaluate and treat hypertensive patients in a variety of contexts, ranging from the compliant patient with well-controlled blood pressure who presents for an unrelated problem, to the patient with asymptomatic blood pressure elevation, to the patient with a true hypertensive urgency or emergency. Recently, the approach to the treatment of adult hypertension has been modified to take into account advances in the understanding of individual patient risk factors and relative risk of cardiovascular complications. Additionally, no data currently exist that show a benefit to acutely lowering the blood pressure of asymptomatic patients with severe blood pressure elevation, but there is data to suggest that it may be harmful, especially in patients with cardiovascular risk factors. From this perspective, the authors define hypertensive urgency and make recommendations for more careful deliberation in management decisions. This article, along with the article on hypertensive emergencies in this issue, provides an approach to the patient presenting to the emergency department with hypertension, elevated blood pressure, or both.