I agree the BP, which could be that way everyday for the last month, isn't stable. Though I was called here for the back pain, my other findings are, in some respect, of more concern.
Be honest with him about the ER trip, whether it is with us or his daughter.
If the BP was 130/85, no, I probably would let him sign the refusal, tell him to call if he changes his mind and wish him well.
I'm guessing here but I might think about doing the Miami Stroke Test