Key result
Routine treatment of asymptomatic elevated blood pressure in non-cardiac hospitalized patients provides no long-term benefits and may cause harm, including acute kidney injury and prolonged hospital stay.
Why the study?
Elevated blood pressure is common in hospitalized patients, but guidelines and data are lacking to assist providers in managing non-cardiac inpatients.
Does routine inpatient hypertension control improve clinical outcomes in non-cardiac hospitalized patients?
Does routine inpatient hypertension control improve clinical outcomes in non-cardiac hospitalized patients?
Routine treatment of asymptomatic elevated blood pressure in non-cardiac hospitalized patients is not recommended as it does not improve long-term outcomes and may cause harm.
Clinicians should avoid routine BP treatment in asymptomatic non-cardiac inpatients; leaves open need for RCTs to confirm harm signals.
PURPOSE OF REVIEW: This review provides a contemporary perspective and approach for the treatment of hypertension (HTN) among patients hospitalized for non-cardiac reasons. RECENT FINDINGS: Elevated blood pressure (BP) is a common dilemma encountered by physicians, but guidelines are lacking to assist providers in managing hospitalized patients with elevated BP. Inpatient HTN is common, and management remains challenging given the paucity of data and misperceptions among training and practicing physicians. The outcomes associated with intensifying BP treatment during hospitalization can be harmful, with little to no long-term benefits. Data also suggests that medication intensification at discharge is not associated with improved outpatient BP control. Routine inpatient HTN control in the absence of end-organ damage has not shown to be helpful and may have deleterious effects. Since routine use of intravenous antihypertensives in hospitalized non-cardiac patients has been shown to prolong inpatient stay without benefits, their routine use should be avoided for inpatient HTN control. Future large-scale trials measuring clinical outcomes during prolonged follow-up may help to identify specific circumstances where inpatient HTN control may be beneficial.
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Chaganti et al. (2022) conducted a review in Hypertension in non-cardiac hospitalized patients. Inpatient hypertension treatment vs. No treatment or continuation of home medications was evaluated. Routine treatment of asymptomatic elevated blood pressure in non-cardiac hospitalized patients provides no long-term benefits and may cause harm, including acute kidney injury and prolonged hospital stay.
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