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Uncontrolled hypertension contributes significantly to cardiovascular morbidity and mortality and is more frequently encountered among patients presenting to the emergency department (ED).1,2 Approximately 50% of patients with previously undiagnosed hypertension who present with elevated blood pressures in the ED will continue to have BP elevations one week after being discharged to home.3 Hypertensive patients presenting to the ED are a particularly high-risk group with >50% with stage II or higher hypertension (SBP ≥160 or DBP ≥100).1 Significant percentages of elevated blood pressures in the ED are incidental findings and not related to the patient's chief complaints. Incidental hypertension represents a quandary for the emergency physician who cannot guarantee follow-up treatment.4,5 Several studies have found that only 7–25% of ED patients with elevated BP are given instructions for outpatient BP follow-up.3–5 Currently, there is no risk assessment or stratification based upon blood pressure assessment performed on hypertensive patients prior to discharge from the emergency department. The emergency medicine literature does not provide definitive recommendations on screening tests for patients with asymptomatic elevated blood pressures.6 Published guidelines regarding the management of these patients only recommend referral of these patients for close primary care follow-up within 48–72 h.6 These same guidelines also urge future research related to the optimal screening for this patient population in the ED.6 The purpose of this study was to determine the progression of subclinical heart disease in an urban ED population with asymptomatic elevated blood pressure and examine the correlation with blood pressure changes after a brief ED hypertension education intervention.