Degtyar Aleksandra, Wilder Marceé E, Richardson Lynne D, Souffront Kimberly T
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, USA.
Curr Hypertens Rep. 2025 Jun 17;27(1):18. doi: 10.1007/s11906-025-01335-6.
This scoping review examines the existing literature to reveal consensus or absence thereof regarding the definition and management strategies for asymptomatic hypertension.
The review used Joanna Briggs Institute guidelines. We searched the CINAHL (EBSCO), Scopus, Ovid EMBASE, and PubMed (MEDLINE) databases using keywords and index terms to identify adult patients with hypertension in an emergency or outpatient setting. After review and quality assessment, we included 35 texts.
The definition of "asymptomatic hypertension" varied widely. There was significant variation in which society or academic guideline served as the reference and what the blood pressure cut offs were; all specified a lack of end-organ damage. End-organ damage was poorly defined- studies instead described the absence of hypertensive emergency. Of the texts which provided recommendations, all recommended a thorough history and physical examination. Only one study recommended additional testing for asymptomatic patients. Treatment recommendations relied predominantly on ACEP clinical policy, with a majority of studies advocating for gradual reduction of blood pressure as well as referral for outpatient management.
Unified guidelines on the definition and management of asymptomatic hypertension are needed to ensure effective and consistent patient care. There is no consensus for diagnostic testing in patients with a negative history and physical exam, nor whether treatment should be initiated in the emergency department. Addressing this gap would enhance clinical outcomes and streamline healthcare processes across systems. Future research should focus on establishing consensus and developing management strategies that are adaptable to both emergency and primary care environments.
本范围综述旨在审视现有文献，以揭示关于无症状高血压的定义和管理策略是否存在共识。
本综述采用乔安娜·布里格斯研究所指南。我们使用关键词和索引词在CINAHL（EBSCO）、Scopus、Ovid EMBASE和PubMed（MEDLINE）数据库中进行检索，以识别急诊或门诊环境中的成年高血压患者。经过审查和质量评估，我们纳入了35篇文献。
“无症状高血压”的定义差异很大。在以哪个社会或学术指南为参考以及血压临界值是多少方面存在显著差异；所有定义都明确缺乏靶器官损害。靶器官损害的定义不明确——研究反而描述了不存在高血压急症的情况。在提供建议的文献中，所有文献都建议进行全面的病史和体格检查。只有一项研究建议对无症状患者进行额外检查。治疗建议主要依赖于美国急诊医师学会的临床政策，大多数研究主张逐步降低血压以及转诊至门诊进行管理。
需要关于无症状高血压定义和管理的统一指南，以确保为患者提供有效且一致的护理。对于病史和体格检查结果为阴性的患者，在诊断检测方面以及是否应在急诊科启动治疗方面尚无共识。填补这一空白将改善临床结局并简化各系统的医疗流程。未来的研究应侧重于达成共识并制定适用于急诊和初级保健环境的管理策略。
