Have a patient with a blood pressure >180/110? Have you diagnosed them with hypertensive urgency? Considering sending them to the ER? Think again…
Asymptomatic hypertensive “urgency” should probably not be treated as urgency. In patients with a systolic BP > 220 that presented to the ER, only 0.2% had a major event 7 days after discharge from the ER.
Instead of sending the patient to the ER and having them wrap up thousands of dollars in medical bills, consider rest, outpatient anti-hypertensives, and routine follow up.
I will routinely start these patients on combination anti-hypertensive medication outpatient and have them return for blood pressure rechecks daily for 3-4 days. Most of the time, the patient will experience a significant decrease in their blood pressure without ill effect, and will be thankful you didn’t sent them to the ER unnecessarily. Even when I work in the ER I just roll my eyes when we get patients from their PCP or an urgent care for a blood pressure of 190/110… I do nothing but give them clonidine and send them home. I have NEVER had an issue. A full workup on an asymptomatic hypertensive patient is a waste of time, money, and resources in the vast majority of cases.
As always though, use your own clinical judgement!