systolic pressure 260. Any circumstances under which emergency room would send patient home?

Question

If a person goes to emergency room with systolic bp of 260, would they automatically be admitted to hospital for observation, or might they be sent home if pressure went down?

Answer 1

No acute end-organ damage, no emergency, no matter what the number is.
The risk of a blood pressure that high is substantial, but it's very safe compared to the risk of lowering it suddenly with medications. There was something of a fad in American medicine about 20 years ago of doctors in emergency departments treating asymptomatic hypertension urgently. Where the risk of having a heart attack or stroke in the next few weeks might be one in ten thousand untreated, treating caused the same problems in one or two percent of patients while they were still in the E.R.
Here's the guiding principle that's hard for young doctors to learn: Don't just do something, stand there!

Answer 2

I have worked in ER many years, about 20 years or so and have seen alot of changes in those years. High Blood Pressure at one time was a cause for admission. Now if the ER doctor can safely bring your blood pressure down and monitor you for a few hours to ensure the bp does not go up again, you can be discharged home with a referral to your doctor. If they are not able to control your bp, then a call is made to your doctor. The on-call doctor will speak to the ER doctor and between them decide if you go home with a early follow-up with your doctor, usually next day or so, or you get admitted.