Additional Reading
1. Axon RN, Turner M, Buckley R. An update on inpatient hypertension management. Curr Cardiol Rep. 2015 Nov;17(11):94.
2. Herzog E, Frankenberger O, Aziz E, et al. A novel pathway for the management of hypertension for hospitalized patients. Crit Pathw Cardiol. 2007;6(4):150-60.
3. Sharma P, Shrestha A. Inpatient hypertension management. ACP Hospitalist. Aug 2014.
Quiz
Asymptomatic hypertension in the hospital
Hypertension is a common focus in the ambulatory setting because of its increased risk for cardiovascular events. Evidence for management in the inpatient setting is limited but does suggest a more conservative approach.
Question: A 75-year-old woman is hospitalized after sustaining a mechanical fall and subsequent right femoral neck fracture. She has a history of hypertension and hyperlipidemia for which she takes amlodipine and atorvastatin. Her blood pressure initially on admission is 170/102 mm Hg, and she is asymptomatic other than severe right hip pain. Her amlodipine and atorvastatin are resumed. Repeat blood pressures after resuming her amlodipine are still elevated with an average blood pressure reading of 168/98 mm Hg. Which of the following would be the next best step in treating this patient?
A. A one-time dose of intravenous hydralazine at 10 mg to reduce blood pressure by 25% over next several hours.
B. A one-time dose of oral clonidine at 0.1 mg to reduce blood pressure by 25% over next several hours.
C. Start a second daily antihypertensive with lisinopril 5 mg daily.
D. Address the patient’s pain.