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In the absence of guidelines, whether to treat patients who develop substantially elevated blood pressure (BP) during hospitalization remains arbitrary. Researchers performed a retrospective cohort study of more than 200,000 non–critically ill adult inpatients (with diagnoses other than hypertensive emergency) at five teaching hospitals in Connecticut. Approximately 23,000 patients met criteria for severe hypertension (defined as systolic BP >180 mm Hg or diastolic BP >110 mm Hg), and 9000 of them received treatment: 21% received intravenous (IV) medications, 63% received oral medications, and 16% received both.
The primary outcome was mean arterial pressure drop of >30% — a measure of potential harm. In adjusted analysis of treated versus u…