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Prior research has shown hypertensive hospitalized patients commonly experience transient elevations in blood pressure (BP) that result in intensification of their outpatient antihypertensive regimens at discharge (NEJM JW Gen Med Nov 15 2018 and BMJ 2018; 362:3503). However, such intensification is associated with risk for harm (e.g., readmission, syncope, acute kidney injury; NEJM JW Gen Med Oct 15 2019 and JAMA Intern Med 2019; 179:1528). In this study, Cleveland Clinic researchers examined clinicians' responses to BPs of 23,000 patients who were hospitalized for noncardiac diagnoses on medical services; outcomes associated with intensification of antihypertensive treatment were recorded.
Eighteen thousand patients had at least one hypertensive BP reading during their hospitalization; of these, 5900 patients received treatment. Overall, 8700 of 106,000 episodes (8%) of hypertensive systolic BPs were treated, and 9% of patients with at least one high BP were discharged with intensified regimens. Intensification at discharge was not associated with improved BP control during the following year. In a propensity-matched analysis, treated patients had significantly higher rates of acute kidney and myocardial injury than did untreated patients. At no specific BP level did treated patients fare better than untreated patients.
Rastogi R et al. Treatment and outcomes of inpatient hypertension among adults with noncardiac admissions. JAMA Intern Med 2020 Dec 28; [e-pub]. (https://doi.org/10.1001/jamainternmed.2020.7501)
Comment
In this study, treating hypertensive episodes during hospitalization and intensifying antihypertensive regimens at discharge were associated with harms and not with improved BP control. As noted by the authors, BP elevations during hospitalization can be due to a number of factors — adaptive or harmful. Before reflexively treating BP elevations, clinicians should assess for potential causes (e.g., pain) and ensure close outpatient follow-up.