Hypertensive emergency department patients frequently have no existing hypertension diagnosis or antihypertensive medications.

Hypertension is highly prevalent and frequently identified in the emergency department (ED), yet recognition and treatment in this setting remain limited. We conducted a retrospective chart review of 200 randomly selected adults discharged from an urban academic ED in 2024 with at least one blood pressure meeting American Heart Association Stage 1 hypertension criteria. We assessed prior diagnosis, medication use, ED discussion, discharge documentation, and antihypertensive initiation. Although 60.5% of patients had no recorded hypertension diagnosis and 60.5% were not taking antihypertensive medications, only 3.0% had documented discussion of elevated blood pressure, 2.5% received discharge instructions addressing hypertension, and 2.0% were prescribed antihypertensive therapy. In only one case was therapy initiated by the emergency physician without specialist involvement. These findings demonstrate substantial missed opportunities for hypertension recognition and management in the ED and highlight the need for systematic screening, counseling, and treatment pathways.