Emergency department blood pressure elevations frequently occur without documented hypertension diagnosis.

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.