A 50 year old male presents to the ED with toe pain. At triage, his BP is noted to be 190/100. Repeat BP in the room is 185/95. He denies any CP, SOB, or vision changes. He believes he has taken an antihypertensive medication in the past given to him by his family doctor but is unsure. How do you manage his BP?

1. Obtain EKG, CXR, UA, and BMP

2. Give labetalol

3. Start a nicardipine drip

4. Do none of the above and advise the patient to follow up with his primary care physician to address his hypertension

Answer: D. This patient has asymptomatic hypertension, not hypertensive emergency (SBP >180 or DBP >120 AND evidence of end-organ dysfunction). Current ACEP guidelines do not recommend routine screening for end-organ dysfunction in hypertensive patients who are otherwise asymptomatic. This does not preclude a good physical exam to be sure that this patient is truly otherwise well. Also, keep in mind that this patient is in pain, which is likely contributing to his BP - always treat pain first!

"Hypertensive Urgency Emergency" June 3 2014. <https://all-about-hipertency.blogspot.com/search/label/hypertensive%20ur.... October 1 2020.

Westafer, Lauren. "Don't Let Hypertension Stress You Out." March 20, 2017. <https://epmonthly.com/article/dont-let-hypertension-stress/>. October 1, 2020.