The Emergency Medicine Cardiac Research and Education Group (EMCREG) recommends no ancillary testing on asymptomatic, healthy patients with a blood pressure reading greater than 160/100 mm Hg as it typically does not impact acute management. This patient, with a history of hypertension, has an asymptomatic elevation of his blood pressure which does not need to be treated in the ED. He can be safely discharged without further testing but should follow up with a primary care provider within 1 week to 1 month.
Findings on ECG may be abnormal in the setting of prolonged hypertension. In a patient where there is concern for ischemia (ie chest pain, dyspnea), an ECG should be obtained; however, in an asymptomatic, otherwise healthy patient, an ECG (B) is of limited utility. There is no evidence to support obtaining a routine CBC (C) in patients with asymptomatic hypertension. A urine drug screen (D) cannot discern exposure of the drug from acute intoxication and therefore serves no utility.
Hoekstra J, Qureshi A. Management of hypertension and hypertensive emergencies in the emergency department: the EMCREG-international consensus recommendations. Ann Emerg Med. 2008;51(3):S1-S38.