What question did this study set out to answer?

Assess the clinical value and potential harms of acutely treating asymptomatic hypertensive urgency in inpatient hospital settings.

October 31, 2018Journal of Hospital MedicineOpen Access

Acute Treatment of Hypertensive Urgency

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Why the study?

Does acute treatment with intravenous or immediate-acting oral antihypertensive medications improve outcomes in hospitalized patients with hypertensive urgency?

Key Points

Assess the clinical value and potential harms of acutely treating asymptomatic hypertensive urgency in inpatient hospital settings.
Narrative review of inpatient clinical management and evidence regarding acute blood pressure reduction for hypertensive urgency within the 'Things We Do for No Reason' series.
Evaluation of hospitalist treatment patterns and clinical guidelines concerning severe blood pressure elevations without acute target-organ damage.
Acute pharmacological lowering of blood pressure in asymptomatic hypertensive urgency does not reduce short-term adverse cardiovascular events or mortality.
Rapid blood pressure reduction may induce avoidable complications, including hypoperfusion, orthostatic hypotension, and prolonged hospital stays.

Structured PICO

Does acute treatment with intravenous or immediate-acting oral antihypertensive medications improve outcomes in hospitalized patients with hypertensive urgency?

Population

Hospitalized patients with hypertensive urgency (asymptomatic severe hypertension, typically systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥120 mm Hg without acute end-organ damage)

Intervention

Acute treatment with intravenous or immediate-acting oral antihypertensive medications

Comparator

Rest and reassessment without immediate administration of antihypertensive medications

Acute pharmacological treatment of asymptomatic hypertensive urgency in hospitalized patients is unnecessary and potentially harmful; management should instead focus on rest, identifying reversible causes, and adjusting chronic oral regimens.

Discussion

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Implication

Prompts reevaluation of low-value inpatient practices; leaves open the need for trials to guide de-implementation.

Cite This Study

Breu et al. (2018) studied this question.

synapsesocial.com/papers/6a7534d60081fe7b05dc0b1f https://doi.org/10.12788/jhm.3086

Topics

Hypertension management

View Full Paper

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Acute Treatment of Hypertensive Urgency

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Acute Treatment of Hypertensive Urgency

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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