2023
DOI: 10.1001/jamainternmed.2023.1667
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Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older Adults

Abstract: ImportanceAsymptomatic blood pressure (BP) elevations are common in hospitalized older adults, and widespread heterogeneity in the clinical management of elevated inpatient BPs exists.ObjectiveTo examine the association of intensive treatment of elevated inpatient BPs with in-hospital clinical outcomes of older adults hospitalized for noncardiac conditions.Design, Setting, and ParticipantsThis retrospective cohort study examined Veterans Health Administration data between October 1, 2015, and December 31, 2017… Show more

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Cited by 21 publications
(7 citation statements)
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“…In addition, the probability for unobserved confounding to substantially contribute to our findings was tested, implying that considerable unmeasured confounding, above and beyond all measured confounders, would be necessary to explain away the observed effect estimate. Although acknowledging the limitations of E-values in estimating residual confounding (20, 49–52), we believe that there is a low probability that unobserved confounding significantly biased our results. Data from a limited geographical region were analyzed and the findings might therefore not be generalizable to other healthcare settings.…”
Section: Discussionmentioning
confidence: 78%
“…In addition, the probability for unobserved confounding to substantially contribute to our findings was tested, implying that considerable unmeasured confounding, above and beyond all measured confounders, would be necessary to explain away the observed effect estimate. Although acknowledging the limitations of E-values in estimating residual confounding (20, 49–52), we believe that there is a low probability that unobserved confounding significantly biased our results. Data from a limited geographical region were analyzed and the findings might therefore not be generalizable to other healthcare settings.…”
Section: Discussionmentioning
confidence: 78%
“…As a result, many post-AKI clinics have made blood pressure control a focus 27 based on both the high rates of CVD risk factors in the post-AKI population and from evidence, such as the SPRINT trial, 8 showing benefit from intensive blood pressure control in populations with CKD. However, data to support specific blood pressure goals in the post-AKI population are sparse, and existing studies 10 , 11 , 12 suggest the possibility of higher short-term complications related to intensive blood pressure lowering. Even within SPRINT, 8 rates of AKI were higher in the intensive control group, a complication which may be more pronounced and more detrimental in the post-AKI population.…”
Section: Discussionmentioning
confidence: 99%
“…While the higher rates of CVD and CVD-related mortality in the post-AKI population suggest a likely benefit from blood pressure reduction, there are concerns that early, intensive blood pressure lowering might result in harms including rehospitalization due to recurrent AKI or electrolyte disturbances such as hyperkalemia. These concerns are supported by the findings of several observational studies in adults without AKI, 10 , 11 , 12 suggesting that aggressive blood pressure control in the inpatient setting, as well as escalation of blood pressure control upon discharge, are associated with increased rates of short-term adverse events, including AKI.…”
Section: Introductionmentioning
confidence: 89%
“…The best available evidence suggests maintaining the prehospitalization antihypertensive medication regimen and avoiding intensification at discharge. 7,24,25 Assessment of the entire medication regimen at discharge is essential, focusing on identifying guideline-discordant antihypertensive regimens because many patients receive antihypertensive medications that do not align with guideline-recommended classes. 42 Any new antihypertensive medication initiated during the admission should align with the 2017 Hypertension Clinical Practice Guidelines 2 and should account for factors that could affect treatment effectiveness and medication adherence such as health literacy, health insurance, affordability, social support, and selfmanagement resources (eg, limited mobility, communication, digital technology, and transportation barriers).…”
Section: Disposition After Hospital Admissionmentioning
confidence: 99%
“…DBP, diastolic blood pressure; HELLP, hemolysis, elevated liver enzymes, low platelets; MAP, mean arterial pressure; PRES, posterior reversible encephalopathy syndrome; and SBP, systolic blood pressure.Data derived from Rossi et al21 as part of the BARKH (brain, arteries, retina, kidney, heart) acronym designed for rapid identification of hypertensive emergencies requiring rapid parenteral treatment. Management of High Blood Pressure in the Acute Care Setting One recent target trial emulation study by Anderson et al24 examined intensive antihypertensive treatment strategies among adults ≥65 years of age who were hospitalized for noncardiac reasons in the national Veterans Affairs health system and had at least 2 elevated inpatient BP measurements in the first 48 hours of hospitalization. Patients who received ≥1 doses of new or intravenous antihypertensives medications in the first 48 hours of hospitalization were categorized as receiving intensive treatment.…”
mentioning
confidence: 99%