A Need for Improved Documentation Among Hypertensive Emergency Department Patients

Hypertension is highly prevalent among emergency department patients, yet the quality of electronic health record (EHR) documentation related to high blood pressure remains uncertain. Accurate identification of existing but uncontrolled or potential new diagnoses of hypertension is important for recognizing patients who may require follow-up care for blood pressure management.

We conducted a retrospective observational study of 84,448 patient visits at a high-volume academic emergency department in 2024. Among 68,293 patient visits (40,836 unique patients) resulting in discharge, we identified patient visits with at least one blood pressure reading consistent with hypertension. Separate variables were coded for at least one blood pressure consistent with Stage 1 hypertension (systolic 130–139 or diastolic 80–89) or Stage 2 hypertension (systolic ≥140 or diastolic ≥90). We evaluated documentation of hypertension on the chronic problem list, demographic characteristics associated with documentation gaps, and patterns of repeat blood pressure measurements.

Of patient visits resulting in discharge, 52,458 (76.8%) had at least one hypertensive blood pressure reading. Within this group, 38,715 visits had one or more blood pressures consistent with at least Stage 2 hypertension (73.8%). For visits with at least Stage 2 hypertension, 22,471 patient visits (58.0%) lacked a formal hypertension diagnosis on the chronic problem list. Younger patients (86.2% of those under 40), White patients (66.7%), men (65.6%), Hispanic and Latino patients (80.0%), those requiring interpreters (83.0%), and individuals with commercial insurance or no insurance (72.8%) were less likely to have a recorded diagnosis. More than forty percent (40.6%) of hypertensive patients had only a single blood pressure recorded. Among patients with medication data recorded, approximately two-thirds (65.2%) did not have an anti-hypertensive medication listed.

Hypertension is widespread among discharged ED patients, but formal diagnoses are often missing even when blood pressures meet hypertension thresholds. Many do not receive repeat vital signs, limiting opportunities for recognition and referral. Improving documentation practices, including EHR prompts tied to hypertensive readings, may enhance identification of at-risk individuals and support outpatient follow-up.