This clinical policy from the American College of Emergency Physicians is the revision of a 2006 policy on the evaluation and management of adult patients with asymptomatic elevated blood pressure in the emergency department.1 A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) In emergency department patients with asymptomatic elevated blood pressure, does screening for target organ injury reduce rates of adverse outcomes? (2) In patients with asymptomatic markedly elevated blood pressure, does emergency department medical intervention reduce rates of adverse outcomes? A literature search was performed, the evidence was graded, and recommendations were given based on the strength of the available data in the medical literature.