13 Jul 2023 • Although recent studies have suggested that aggressive treatment of asymptomatic hospitalized patients with elevated blood pressure (BP) is unnecessary or even harmful, clinical practice continues to vary. large retrospective study adds to a growing body of literature that suggests intensive treatment of hypertension among hospitalized adults without signs of end-organ damage is detrimental.

In this retrospective study of 60,000 U.S. Veterans Affairs patients (age, ≥65) hospitalized for noncardiac conditions, researchers examined the effect of intensive treatment of elevated BP (≥2 episodes of systolic BP >140 mm Hg) within the first 48 hours of hospitalization. Intensive treatment was defined as ≥1 intravenous or oral dose of antihypertensive medications that were not taken prior to hospitalization.

Intensive treatment occurred in 21% of patients and was associated significantly with excess risks for intensive care transfer, acute kidney injury, hypotensive episode with systolic BP <100 mm Hg, B-type natriuretic peptide elevation, and troponin elevation. Highest risks were noted among patients who received intravenous antihypertensives.

The study findings suggest management should focus on treating underlying factors that can cause transient BP elevations (e.g., pain, anxiety, nausea, urinary retention) while minimizing use of BP-lowering agents — especially intravenous agents — in inpatients with asymptomatic elevated BPs.

Source: JAMA Internal Medicine | Read full story