Intensive treatment of elevated blood pressure in hospitalized patients associated with adverse events

Clinical Question

Should clinicians treat elevated blood pressure in asymptomatic hospitalized patients?

Bottom line

Intensive treatment of elevated BP in asymptomatic hospitalized older adults may be associated with an increased risk of adverse events, specifically acute kidney injury, transfer to intensive care, and elevation of troponin and BNP levels. This association was not seen in the subgroup of patients with a maximum BP of 180 mmHg or greater during initial hospitalization. Given the observational design and the use of administrative data, the study results may be affected by unmeasured confounding factors, misclassification of antihypertensive exposure, and inadvertent inclusion of symptomatic patients. Although more research is needed, this data suggests that knee-jerk treatment of elevated BP in the hospital may not be warranted. 2b

Study design: Cohort (retrospective)

Funding: Government

Setting: Inpatient (ward only)

Reviewer

Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL


Discuss this POEM


Comments

Pieter Richard Verbeek

Intensive treatment of elevated blood pressure in hospitaliz

Couldn't agree with this more. Extrapolating this to the ED, one should avoid the urge to "urgently treat" patients with BP at these levels who don't have any evidence of a hypertensive urgency. Typically these are patients who have taken their BP at home and are worried. The best "treatment" we can offer is to reassure the patient that there is nothing urgent that needs to be done in the ED. This paper provides a hint that doing otherwise could actually be harmful.

Arup Kumar Dhara

Impact assessment

Excellent

Anonymous

intensive treating blood pressure adverse effects

good to know