Elevated blood pressure (BP) is reported in many individuals without hypertension presenting to the emergency department (ED). Whether this condition represents a transient state or is predictive for the development of future hypertension is unknown. This observational prospective study investigated patients admitted to an ED without a diagnosis of hypertension in whom BP values were ≥140/90 mm Hg. The primary outcome was development of hypertension during follow-up. Overall, 195 patients were recruited and at the end of follow-up (average 30.14AE15.96 months), 142 patients were diagnosed with hypertension (73% Admission to the emergency department (ED) is certainly a stressful situation. Many patients without a diagnosis of hypertension admitted to the ED with various etiologies have blood pressure (BP) >140/90 mm Hg.1 Possible causes for this increment in BP in the ED setting is pain and anxiety. On the other hand, other patients with the same pain and anxiety level do not have increased BP. This increase of BP in the ED setting may be viewed as a form of white-coat hypertension, an entity associated with the future development of hypertension.2-6 Yet, it is unclear whether patients with high BP values recorded in the ED setting are also at increased risk for the development of future hypertension. We conducted a prospective study in which patients without a history of hypertension in whom BP measurements recorded in the ED were ≥140/ 90 mm Hg were followed for the development of hypertension. METHODS Study PopulationThis was an observational prospective study in which patients aged 18 to 80 years admitted to the ED of Rabin Medical Center were evaluated. Rabin Medical Center is a tertiary center located in central Israel and its ED is the third largest in Israel, with more than 150,000 annual visits. The study population included patients without a previous diagnosis of hypertension and with a discharge diagnosis of elevated BP in the years 2009 to 2010. Hypertension was defined by a persistent record of elevated office BP values ≥140/90 mm Hg, an average BP >135/85 mm Hg on ambulatory BP monitoring, or treatment with antihypertensive medications. Patients were followed prospectively until May 2014. The study was approved by the Rabin Medical Center institutional review board. Inclusion and Exclusion CriteriaPatients were included if they were aged 18 to 80 years without a prior diagnosis of hypertension in which BP recorded in the ED was ≥140/90 mm Hg. Patients with a prior diagnosis of primary or secondary hypertension were excluded from the study. A history of hypertension was excluded when "hypertension" was not listed as one of the chronic medical problems in the patient's medical file, when persistent office BP values ≥140/90 mm Hg or an average BP >135/85 mm Hg on ambulatory BP monitoring were not recorded, and when antihypertensive medications were not dispensed prior to the ED visit.BP Measurement and Data Collection BP measurement was performed by a nurse or a physician with the patient in a sitting...

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Antihypertensive drug therapy is more commonly prescribed in the ED in individuals with both elevated systolic and diastolic BP, but leads to a significant decrease only in systolic BP. Use of either ACEis or CCBs is not associated with a significant decrease in either systolic or diastolic BP compared with other drug classes.

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