The objective is of the study to evaluate the effect of antihypertensive therapy in emergency department (ED) patients with markedly elevated blood pressure (BP) but no signs/symptoms of acute target organ damage (TOD).

This is a retrospective cohort study of ED patients age 18 years and older with an initial BP greater than or equal to 180/100 mm Hg and no acute TOD, who were discharged with a primary diagnosis of hypertension. Patients were divided based on receipt of antihypertensive therapy and outcomes (ED revisits and mortality) and were compared.

Of 1016 patients, 435 (42.8%) received antihypertensive therapy, primarily (88.5%) oral clonidine. Average age was 49.2 years, and 94.5% were African American. Treated patients more often had a history of hypertension (93.1% vs 84.3%; difference = −8.8; 95% confidence interval [CI], −12.5 to −4.9) and had higher mean initial systolic (202 vs 185 mm Hg; difference = 16.9; 95% CI, −19.7 to −14.1) and diastolic (115 vs 106 mm Hg; difference = −8.6; 95% CI, −10.3 to −6.9) BP. Emergency department revisits at 24 hours (4.4% vs 2.4%; difference = −2.0; 95% CI, −4.5 to 0.3) and 30 days (18.9% vs 15.2%; difference = −3.7; 95% CI, −8.5 to 0.9) and mortality at 30 days (0.2% vs 0.2%; difference = 0; 95% CI, −1.1 to 0.8) and 1 year (2.1% vs 1.6%; difference = −0.5; 95% CI, −2.5 to 1.2) were similar.

Revisits and mortality were similar for ED patients with markedly elevated BP but no acute TOD, whether they were treated with antihypertensive therapy, suggesting relative safety with either approach.