Clinical question: How do clinical outcomes compare between patients with asymptomatic hypertension treated intensively versus not while hospitalized?
Dr. Richardson
Background: While the long-term cardiac effects of untreated hypertension are clear, the short-term in-hospital consequences of hypertension remain uncertain. Previous studies have indicated that lowering blood pressure in hospital can lead to hypotension and acute kidney injury (AKI).
Study design: Retrospective observational cohort study
Setting: Veterans Affairs (VA) hospital
Synopsis: In a study of 66,000 white, male, VA patients aged over 65, 14,000 received intensive blood pressure control with intravenous (IV) or additional oral antihypertensives due to elevated blood pressures early during their hospital stay. Those who received intensive blood pressure treatment faced a higher risk of the primary outcome (a composite of inpatient mortality, AKI, stroke, myocardial injury, beta-type natriuretic peptide elevation, and intensive care unit (ICU) transfer) with an odds ratio of 1.28. They were also more likely to experience each component of the composite outcome, except for stroke and mortality. The HRs for myocardial injury and AKI were 1.23 and 1.26 respectively. Patients treated with IV antihypertensives had higher composite primary outcomes, death, ICU transfer, and myocardial injury. The results suggest that treating asymptomatic hypertension should be approached with caution, emphasizing the need to address the underlying causes of elevated blood pressure. However, given the study’s predominantly older, white, male, VA-patient population, its findings may not be generalizable to a broader demographic.
Bottom line: Intensive blood pressure control in older patients with asymptomatic hypertension is associated with increased adverse outcomes, with IV antihypertensives posing a greater risk than oral medications.
Citation: Anderson TS, et al. Clinical outcomes of intensive inpatient blood pressure management in hospitalized older adults. JAMA Intern Med. 2023;183(7):715-23.
Dr. Richardson is a hospitalist and assistant professor in the department of internal medicine, division of hospital medicine at the University of New Mexico Hospital, Albuquerque, N.M.