Slow on the Draw-ED Management of Elevated BP in Older Adults

Curr Hypertens Rep. 2024 Mar;26(3):107-117. doi: 10.1007/s11906-023-01284-y. Epub 2023 Nov 21.


Purpose of review: The purpose of this study is to review data surrounding the emergency department management of elevated blood pressure in older adults, including the management of hypertensive crisis and outpatient management of markedly elevated blood pressure.

Recent findings: Acute lowering of blood pressure in older adults with markedly elevated blood pressure may lead to serious complications without improvements in hospital length of stay, return visits, or mortality. Older adults presenting with elevated blood pressures without evidence of end-organ damage should be referred for outpatient management of their blood pressure. Treatment of hypertensive emergency should follow standard guidelines with additional considerations for aging physiology. Acute lowering of elevated blood pressure in older adults without evidence of end-organ damage has the potential for harm. If the emergency physician opts to acutely treat, they should consider the increased risk of side effects in older adults and avoid Beers list medications including short-acting nifedipine and clonidine.

Keywords: Blood pressure management; Emergency department; Geriatrics; Hypertension; Hypertensive crisis; Older adults.

Publication types

  • Review

MeSH terms

  • Aged
  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / physiology
  • Emergency Service, Hospital
  • Humans
  • Hypertension*
  • Hypertensive Crisis*
  • Nifedipine / therapeutic use


  • Nifedipine
  • Antihypertensive Agents