• Peter M Mullins, Phillip D Levy, Maryann Mazer-Amirshahi, and Jesse M Pines.
• Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, United States. Electronic address: petermmullins@gmail.com.
• Am J Emerg Med. 2020 Aug 1; 38 (8): 1652-1657.

ObjectivesHypertension is one of the most common chronic illnesses among adults in the United States. While poor hypertension control is a risk factor for many emergent conditions, asymptomatic hypertension is rarely an emergency. Despite this, patients may present to the emergency department (ED) with a chief complaint of hypertension, and there may be significant variability in the management of these patients. Our objective was to characterize national trends in ED visits for chief complaint of hypertension between 2006 and 2015.MethodsWe used the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2006 to 2015 to examine ED visits for chief complaint of hypertension. We examined trends in demographics, diagnostic resource utilization, and clinical management of these patients.ResultsBetween 2006 and 2015, visits with hypertension as the primary chief complaint represented 0.6% of all ED visits, or 6,215,787 national-level ED visits. Of these, 63.9% received a primary diagnosis of hypertension. While there was no significant growth in these visits over the study period, 79.3% of visits received any form of diagnostic testing, with 35.5% of patients receiving an antihypertensive medication. Increasing blood pressure and non-white race were associated with increased odds of receiving antihypertensive medications.ConclusionsDespite clinical policies and guidelines recommending against routine diagnostic testing for asymptomatic hypertension, roughly 4 out of 5 ED visits received diagnostic testing, and more than 1 out of 3 received medications. These visits may represent an opportunity for improvement to reduce overutilization, as well as for innovative approaches as EDs expand their role in care coordination across settings.Copyright © 2019 Elsevier Inc. All rights reserved.

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