Prevalence and management of hypertension in the inpatient setting: A systematic review

Axon, R. Neal; Cousineau, Laura; Egan, Brent M.

doi:10.1002/jhm.804

Cited by 41 publications

(43 citation statements)

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“…Further evidence for a high prevalence of HTN among hospitalized patients comes from a report that over 35 % of males and 39 % of females have HTN listed as a secondary diagnosis at the time of hospital discharge [7]. Finally, a systematic review of reports describing inpatient HTN prevalence based on BP measurements found estimates ranging from 50.5 to 72 % [8].…”

Section: Introductionmentioning

confidence: 97%

“…Some evidence suggests that nonemergent HTN is overdiagnosed and overtreated in the inpatient setting [20,21]. Additional reports suggest opportunities to improve follow-up care for hypertensive patients after hospital discharge [8]. This review focuses on the diagnosis and management of nonemergent elevated BP observed in the inpatient setting.…”

Section: Introductionmentioning

confidence: 98%

“…This topic has been less often addressed in the medical literature and approaches to care are often inconsistent [8,15,16]. Optimal management of such patients is unclear at least in part because current and past evidence-based guidelines to not specifically address inpatients [17].…”

Section: Introductionmentioning

confidence: 98%

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An Update on Inpatient Hypertension Management

2015

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Hypertension is highly prevalent affecting nearly one third of the US adult population. Though generally approached as an outpatient disorder, elevated blood pressure is observed in a majority of hospitalized patients. The spectrum of hypertensive disease ranges from patients with hypertensive emergency including markedly elevated blood pressure and associated end-organ damage to asymptomatic patients with minimally elevated pressures of unclear significance. It is important to note that current evidence-based hypertension guidelines do not specifically address inpatient hypertension. This narrative review focuses primarily on best practices for diagnosing and managing nonemergent hypertension in the inpatient setting. We describe examples of common hypertensive syndromes, provide suggestions for optimal post-acute management, and point to evidence-based or consensus guidelines where available. In addition, we describe a practical approach to managing asymptomatic elevated blood pressure observed in the inpatient setting. Finally, arranging effective care transitions to ensure optimal ongoing hypertension management is appropriate in all cases.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

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An Update on Inpatient Hypertension Management

2015

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“…These figures are consistent with the high percentage (>50%) reported in the past 15 years. A review of the peer-reviewed literature on hypertension since 1976 using a predetermined search algorithm revealed that between 56.4% and 72.6% of inpatients had hypertension [3]. Two crosssectional studies in 2006 and 2009 from single-university centers in the U.S. and Italy reported hypertension prevalence of 72.6% among hospitalized patients [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Many patients who have persistently elevated BP in the hospital setting will continue to have high BP following hospital discharge [3]. Therefore; it may be worthwhile to identify these patients and to control their BP while they are hospitalized at internal medicine departments.…”

Section: Introductionmentioning

confidence: 99%

Blood Pressure Control during Hospitalization at the Department of Medicine

Elis¹

2015

Arch Clin Hypertens

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Introduction: Hypertension control has been shown to decrease morbidity and mortality. However, it is unclear whether it is worthwhile to control blood pressure (BP) in the inpatient setting. The aim of the study was to determine physicians' attitude towards the management and control of hypertension during hospitalization at internal medicine departments. Methods:Physicians working in general medical wards were asked to answer a questionnaire regarding their views of various aspects of hypertension control and management during hospitalization in general medical wards. Results:One hundred twenty-seven physicians responded, 58 (46%) of them estimated that 50% of their inpatients have a diagnosis of hypertension. The majority of the respondents (71, 56%) believe that high BP should not be balanced during hospitalizations. According to the physicians report most of the BP measurements were done by nurses (81%) or by non-certified staff (17%). In most of the cases, the arm where BP was measured was not recorded (81%), and measurements in both supine and standing positions were not accomplished (in <10% of the cases according to 50% of respondents). In most of the departments (70%) there are no specific guidelines for the treatment of hypertension. Two thirds of the physicians do not recommend antihypertensive combination medications. Conclusions:Many patients who are hospitalized at internal medicine departments have hypertension, but there is a lack of uniformity with regard to these patients' BP measurements and treatment. The approach to BP management in internal medicine departments should be elucidated.The aim of this study was to evaluate the attitude of physicians at the internal medicine departments throughout Israel towards the management and control of hypertension during hospitalization.

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Treatment and Outcomes of Inpatient Hypertension Among Adults With Noncardiac Admissions

Rastogi

Sheehan

et al. 2021

JAMA Intern Med

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IMPORTANCE 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.OBJECTIVES 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.DESIGN, SETTING, AND PARTICIPANTS 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.EXPOSURES Acute hypertension treatment, defined as administration of an intravenous antihypertensive medication or a new class of an oral antihypertensive treatment. MAIN OUTCOMES AND MEASURESThe 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 (mean [SD] age, 65.6 [17.9] years; 12 993 women [56.9%]; 15 963 White patients [69.9%]), 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 (466 of 4520 [10.3%] vs 357 of 4520 [7.9%]; P < .001) and myocardial injury (53 of 4520 [1.2%] vs 26 of 4520 [0.6%]; P = .003). 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. CONCLUSIONS AND RELEVANCEIn 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.

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Prevalence and management of hypertension in the inpatient setting: A systematic review

Cited by 41 publications

References 24 publications

An Update on Inpatient Hypertension Management

An Update on Inpatient Hypertension Management

Blood Pressure Control during Hospitalization at the Department of Medicine

Treatment and Outcomes of Inpatient Hypertension Among Adults With Noncardiac Admissions

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