From the Guidelines
The optimal approach for managing a hospitalized patient with fluctuating blood pressure readings is to avoid intensive antihypertensive treatment and instead focus on identifying and addressing the underlying causes of the blood pressure fluctuations.
Key Considerations
- Lack of evidence for the benefits of intensive inpatient antihypertensive treatment 1
- Potential harms of overtreatment, including acute kidney injury, stroke, and myocardial injury 1
- Wide variation in practice patterns for managing elevated blood pressure in the inpatient setting 1
Management Approach
- Monitor blood pressure closely to identify patterns and trends
- Assess for underlying causes of blood pressure fluctuations, such as pain, anxiety, or fluid overload
- Use antihypertensive medications judiciously, taking into account the patient's individual risk factors and medical history
- Consider alternative explanations for elevated blood pressure, such as white coat hypertension or measurement error
Guideline Recommendations
- Inpatient blood pressure goals should be individualized based on the patient's clinical condition and medical history 1
- Follow-up after hospitalization is important to ensure that blood pressure is well-controlled and to adjust treatment as needed 1
From the Research
Managing Fluctuating Blood Pressure in Hospitalized Patients
- The optimal approach for managing a hospitalized patient with fluctuating blood pressure readings, characterized by episodes of hypertension and hypotension, is not clearly defined in current evidence-based guidelines 2, 3, 4, 5, 6.
- Studies suggest that routine inpatient hypertension control in the absence of end-organ damage has not shown to be helpful and may have deleterious effects 3, 5.
- The risk-benefit ratio of initiating or intensifying antihypertensive medications for asymptomatic elevated inpatient blood pressure is less clear, and recent observational studies have suggested potential harms associated with treating asymptomatic elevated inpatient blood pressure 4, 5.
- Conscientious adjustment of an anti-hypertensive regimen should be undertaken during episodes of elevated blood pressure associated with end-organ damage 5.
- Hypertensive emergency, which involves acute target-organ damage, should be treated swiftly, usually with intravenous antihypertensive medications, in a closely monitored setting 4.
Key Considerations
- Elevated blood pressure is common in hospitalized patients, and many factors can influence blood pressure, such as pain, anxiety, malaise, nicotine withdrawal, or withholding home medications 5.
- There are no normal reported values for blood pressure in the inpatient setting, and recording circumstances often widely vary 5.
- The routine use of intravenous antihypertensives in hospitalized non-cardiac patients has been shown to prolong inpatient stay without benefits, and their routine use should be avoided for inpatient hypertension control 3.