Conservative therapy for inpatient hypertension bests antihy
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Despite high prevalence of elevated blood pressure (BP) among medical inpatients, BP management guidelines are lacking for this population. The outcomes associated with intensifying BP treatment in the hospital are poorly studied.

This study aimed to characterize clinician response to BP in the hospital and at discharge and to compare short- and long-term outcomes associated with antihypertensive treatment intensification.

This cohort study took place from January 1 to December 31, 2017, with 1 year of follow-up at 10 hospitals within the Cleveland Clinic Hospitals health care system. All adults admitted to a medicine service in 2017 were evaluated for inclusion. Patients with cardiovascular diagnoses were excluded. Demographic and BP characteristics were used for propensity matching. Acute hypertension treatment was defined as administration of an intravenous antihypertensive medication or a new class of an oral antihypertensive treatment.

The association between acute hypertension treatment and subsequent inpatient acute kidney injury, myocardial injury, and stroke was measured. Postdischarge outcomes included stroke and myocardial infarction within 30 days and BP control up to 1 year.

Results:
-- Among 22 834 adults hospitalized for noncardiovascular diagnoses, 17 821 (78%) had at least 1 hypertensive BP recorded during their admission.

-- Of these patients, 5904 (33.1%) were treated. A total of 8692 of 106 097 cases (8.2%) of hypertensive systolic BPs were treated; of these, 5747 (66%) were treated with oral medications.

-- In a propensity-matched sample controlling for patient and BP characteristics, treated patients had higher rates of subsequent acute kidney injury and myocardial injury.

-- There was no BP interval in which treated patients had better outcomes than untreated patients.

-- A total of 1645 of 17 821 patients (9%) with hypertension were discharged with an intensified antihypertensive regimen.

-- Medication intensification at discharge was not associated with better BP control in the following year.

Conclusively, in this cohort study, hypertension was common among medical inpatients, but antihypertensive treatment intensification was not. Intensification of therapy without signs of end-organ damage was associated with worse outcomes.

Source: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2774562
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