Asymptomatic hypertension

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Classification of Hypertension

JNC-7 recommends 2 or more properly measured, seated blood pressure readings on each of 2 or more office visits to establish the diagnosis of hypertension[1]

Class Systolic Diasolic
Normal <120 and <80
Pre-hypertension 120-130 or 80-89
Stage 1 140-150 or 90-99
Stage 2 ≥160 or ≥100
  • JNC-8 Changes: In patients ≥60 yr the threshold has increased from <140/90 to <150/90[2]
  • Any age with diabetes mellitus and >140/90

Clinical Features

  • None (asymptomatic by definition)

Differential Diagnosis



Asymptomatic hypertension

  • Urine pregnancy in all women of child-bearing age (consider preeclampsia if positive)
Routine screening for acute target organ injury (e.g. creatinine, UA, ECG) is NOT required (Level C)[3]
In select patient populations, screening of creatinine may identify injury that affects disposition (Level C)[3]

Suggested algorithm:

  • <120 diastolic
    • No screening ED workup --> home with outpatient treatment
  • >210 systolic or >120-130 diastolic
    • Chem 7 (creatinine) --> home with outpatient treatment if no evidence of acute renal failure
      • "No other diagnostic screening tests (e.g. UA, ECG) appear to be useful"[3]


Asymptomatic hypertension

Routine ED medical intervention is NOT required (Level C)[3]
  • In select patient populations, consider initiating or increasing outpatient therapy for long-term control (Level C)[3]

Initial outpatient hypertension medications

JNC 8 Recommendations[2]

Population Non-black Patients Black Patients
General population thiazide, CCB, ACEI, or ARB thiazide or CCB
DM thiazide, CCB, ACEI, or ARB thiazide or CCB


See Also


  1. Chobanian AV, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure - The JNC 7 Report. JAMA. 2003; 289(19):2560-2572.
  2. 2.0 2.1 James PA, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311(5):507-520.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients in the Emergency Department with Asymptomatic Elevated Blood Pressure. ACEP Clinical Policies Subcommittee on Asymptomatic Hypertension. Annals of Emergency Medicine. 2013; 62(1):59-63.