Cardiovascular

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

TL;DR

More than half of discharged ED patients with Stage 2-range high blood pressure readings lacked a documented diagnosis of hypertension, suggesting the ED may provide an opportunity for blood pressure reassessment and outpatient referral.

Key Findings

High blood pressure readings were extremely common among discharged ED patients, affecting more than three-quarters of encounters.

  • Study included 66,624 discharged ED encounters with blood pressure data from a large Midwestern academic ED in 2024.
  • 52,461 encounters (78.7%) had at least one high blood pressure reading (HBPR), defined as ≥130 mmHg systolic or ≥80 mmHg diastolic.
  • 38,715 encounters (58.1%) had at least one Stage 2-range HBPR (≥140/90 mmHg).
  • This was a retrospective study of discharged encounters only.

The majority of ED patients with Stage 2-range high blood pressure readings lacked a documented diagnosis of hypertension.

  • Among the 38,715 patients with Stage 2-range HBPRs, 22,471 (58.0%) lacked a documented diagnosis of hypertension (DDxHTN).
  • This means more than half of discharged ED patients with clinically significant blood pressure elevations had no formal hypertension diagnosis on record.
  • Many of these patients had only a single documented blood pressure reading.

Several demographic and insurance-related factors were independently associated with having a documented diagnosis of hypertension among patients with Stage 2-range HBPRs.

  • Older age was independently associated with having a documented diagnosis of hypertension (DDxHTN).
  • Female sex was independently associated with DDxHTN.
  • Black race was independently associated with DDxHTN.
  • Absence of interpreter need was independently associated with DDxHTN.
  • Medicare or Medicaid coverage was independently associated with DDxHTN.

The emergency department was identified as a potential setting for blood pressure reassessment and outpatient referral for undiagnosed hypertension.

  • A large proportion of patients with Stage 2-range HBPRs lacked any prior documented hypertension diagnosis.
  • Many affected patients had only a single blood pressure measurement documented during their ED visit.
  • The authors suggest the ED 'may provide an opportunity for blood pressure reassessment and outpatient referral.'
  • The study was conducted at a single large Midwestern academic ED, which may limit generalizability.

What This Means

This research examined how often patients seen in an emergency department (ED) had high blood pressure readings and whether those patients had ever been formally diagnosed with hypertension. Looking at over 66,000 discharged patient visits at a large academic hospital in 2024, the researchers found that nearly 79% of patients had at least one elevated blood pressure reading, and about 58% had readings in the range considered Stage 2 hypertension (140/90 mmHg or higher). Strikingly, more than half of the patients with these higher-range readings had no documented hypertension diagnosis in their records. The study also found that certain groups were more likely to have a formal hypertension diagnosis: older patients, women, Black patients, those who did not need an interpreter, and those covered by Medicare or Medicaid. This suggests that some populations — such as younger patients, non-English speakers, or those without certain types of insurance — may be less likely to have hypertension formally recognized and recorded, even when their blood pressure is elevated. This research suggests that emergency departments, while primarily focused on acute care, may represent an underutilized opportunity to identify people with unrecognized high blood pressure and connect them with follow-up care. Since many patients had only a single blood pressure measurement recorded during their visit, the findings also highlight the need for repeat measurements and structured pathways to refer patients with elevated readings to primary care providers for proper evaluation and management.

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Citation

Kuhn D, Musey P, Pollard K, Parrelli G, Levy P. (2026). Emergency department blood pressure elevations frequently occur without documented hypertension diagnosis.. Journal of hypertension. https://doi.org/10.1097/HJH.0000000000004417