Physicians' Beliefs About Treating Asymptomatic Elevated Blood Pressure Readings Among Hospitalized Patients

Currently, there is no high-quality evidence guiding the treatment of asymptomatic elevated BP readings in hospitalized patients.

We conducted a nationwide survey of hospitalists to identify their preferences for treating patients with asymptomatic elevated BP readings.

This cross-sectional survey was conducted at five institutions in 2024. The questions, written by the research team, asked about physicians' approach and preferences for intensifying antihypertensive medications for inpatients with asymptomatic elevated BP. We defined "elevated BP" as ≥ 140/90 mmHg and < 210/120 mmHg. We performed a descriptive analysis of the responses and compared responses across sites.

We received 166 responses (response rate ranged from 24 to 64% across five hospitals). There was variation in the importance of treating asymptomatically elevated BP with 27% (n = 45) agreeing it important and 47% disagreeing. This response was similar across all sites. The median threshold for intensification was 170-179 mmHg. Most physicians reported that they would be more likely to treat patients with a history of heart failure (73%), stroke (73%), myocardial infarction (64%), or coronary disease (57%). Physicians reported strong agreement that they "prefer not to be contacted by nurses about an asymptomatic systolic BP reading < 170 mmHg" and agreed that "treatment is driven by nurses calling physicians."

Almost half of the physicians believed that in the hospital setting, asymptomatic elevated BP should not be routinely treated.