Acute elevated blood pressure in the inpatient setting

Elevated blood pressure (BP) in the inpatient setting is frequently encountered by most healthcare providers. While there is general consensus on the management of acute BP elevations when associated with end-organ damage, these cases of true hypertensive emergency are relatively infrequent. In contrast, asymptomatic acute BP elevations are considerably more frequent, yet there is little consensus on their appropriate management. Contributing factors include concerns about missing true emergencies, the barriers affecting the accuracy of inpatient BP measurements and a lack of consistent data on the short- and long-term impact of inpatient BP elevations. Practice varies widely, even between departments within the same hospital, and includes observation, intravenous antihypertensives, oral agents and adjustments to existing regimens. Some clinicians also choose to discharge patients on intensified therapy based on inpatient BP values. However, despite the high prevalence of elevated BP in the inpatient setting, evidence remains heterogeneous and fragmented. This review aims to synthesise current knowledge and provide a practical, holistic framework for evaluating and managing elevated BP in the inpatient setting.