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An Evidence-Based Review of Elevated Blood Pressure for the Inpatient
Bryan Stanistreet1, Joseph A Nicholas1, John D Bisognano2
1Department of Internal Medicine, Division of Geriatrics, University of Rochester Medical Center, Rochester, NY.
The American Journal of Medicine
|November 10, 2019
Summary
Hospitalized patients often have elevated blood pressure without clear guidelines. Treating asymptomatic high blood pressure may cause harm and offers little benefit, except in hypertensive emergencies.
Area of Science:
- Internal Medicine
- Cardiology
- Clinical Practice Guidelines
Background:
- Elevated blood pressure is frequent in hospitalized patients.
- Lack of established guidelines complicates inpatient hypertension management.
- Inpatient blood pressure values are variable and lack normal reference ranges.
Purpose of the Study:
- To review the literature on managing elevated blood pressure in hospitalized patients.
- To assess the risks and benefits of treating asymptomatic hypertension in inpatients.
- To identify indications for antihypertensive treatment in the inpatient setting.
Main Methods:
- Literature review of available studies on inpatient hypertension.
- Analysis of factors influencing blood pressure readings in hospitalized individuals.
- Evaluation of evidence for treating asymptomatic elevated blood pressure.
Main Results:
- Treating asymptomatic elevated blood pressure in inpatients shows potential harm and minimal benefit.
- No evidence suggests asymptomatic elevated blood pressure leads to end-organ damage.
- Hypertensive emergencies and elevated blood pressure with end-organ damage warrant treatment.
Conclusions:
- Current evidence does not support routine treatment of asymptomatic elevated blood pressure in hospitalized patients.
- Treatment should be reserved for hypertensive emergencies or when end-organ damage is present.
- Careful adjustment of antihypertensive regimens is crucial for patients with end-organ damage.
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