The clinical evaluation of hypertensive patients is aimed at determining the underlying reason for the hypertensive episode and ascertaining the effects on end organs. Management is determined by this assessment. Although patients with hypertension present to the ED relatively frequently, the number of individuals who actually require emergent intervention is small.10 ED management should begin with an accurate blood pressure measurement, confirmed by repeat assessment in both arms if the initial value is elevated. The challenge is to determine whether the presenting blood pressure reading is only a transient circumstantial elevation or is representative of the patient's baseline. The approach to hypertensive patients in the ED is summarized in the flow diagram in Fig 5.3,-1.
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