ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Asymptomatic hypertension in the emergency department usually does not need emergent testing after a careful history and physical exam. The 2025 ACEP clinical policy supports considering antihypertensive initiation at ED discharge and emphasizes prompt outpatient follow-up.
Asymptomatic Hypertension in the ED
- No emergent workup needed: A focused history and physical exam is the key screen for true asymptomatic elevated blood pressure; without symptoms or exam red flags, routine ED testing is generally not required.
- Discharge prescribing shift: The 2025 ACEP policy recommends clinicians consider starting an antihypertensive at discharge for selected adults with asymptomatic hypertension rather than deferring all treatment.
- Level C recommendation: This is a Level C ACEP recommendation, which makes the guidance usable but still dependent on bedside judgment, patient context, and reliability of follow-up.
- Rapid follow-up matters: Starting treatment is paired with quick outpatient follow-up, since the ED visit can open the door to longitudinal blood pressure control. We get into the practical handoff in the episode.
- Agent selection guidance: The policy offers general direction on which antihypertensive classes to consider at discharge, while leaving patient-specific drug choice and exceptions to clinical judgment.
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References:
- American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Asymptomatic Hypertension, Gemme S, Meltzer AC, et al. Clinical Policy: A Critical Issue in the Outpatient Management of Adult Patients Presenting to the Emergency Department With Asymptomatic Elevated Blood Pressure: Approved by the ACEP Board of Directors January 22, 2025. Ann Emerg Med. 2025;86(1):e1-e11. PMID: 40543987
Faculty
- Geoffrey Comp, DO, FACEP
Dr. Comp is an Associate Program Director for the Creighton University / Valleywise Health Emergency Medicine Residency Program in Phoenix. A clinician-educator at heart, Geoff spends his time mentoring the next generation of Emergency Medicine residents and advocating for better ways to teach and learn medicine. His professional world revolves around wilderness medicine, clinician wellness, and finding innovative ways to bridge the gap between theory and the bedside. When he isn’t in the ED or the classroom, you’ll likely find him combining his love for medicine with his passion for the outdoors, always looking for a new trail to explore or a new way to collaborate with fellow clinicians.
- Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
- Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
