Pearls regarding truly asymptomatic, but severely elevated, BP: 1. Repeat blood pressure a few times in the ED before acting on it. Many patient's blood pressure will regress to the mean. 2. Anyone being discharged with elevated BP should have some type of plan for followup. Avoid "followup with your doctor as needed." 3. No evidence exists that acute lowering of BP in an asymptomatic patient does any good (despite scary BP numbers). Avoid "treating the numbers." and.... 4. Avoid NSAIDS in patients with out of control BPs. NSAIDS induce sodium retention and essentially obliterate the effects of antihypertensive medications.