Spontaneous fall in blood pressure and reactivity of sympathetic nervous system in hospitalized patients with essential hypertension.

Abstract

Weevaluated whether reduction in sympathetic reactivity plays a major role in the spontaneous falls in blood pressure (BP) experienced during hospitalization by patients with essential hypertension. In the present case BP fell on the 2nd day of hospitalization. The responses of plasma catecholamines (CA) and BP to both handgrip and tilting were not altered during either the first 24 hours or the entire 7 days of hospitalization. The effect of phentolamine on BPwas similar on the 1st, 2nd and 7th days. However, the resting levels of plasma norepinephrine before handgrip, tilting and phentolamine were significantly diminished on the 7th day, but not on the 2nd day. In conclusion, the diminution of sympathetic activity may be partly responsible for the hospitalization-induced fall in BPin the late stages.

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

“…Inpatient populations have increased in age and comorbidity over the past 3 decades whereas lengths of stay and continuity of care between the inpatient and outpatient arenas have diminished 10, 11. Multiple prior studies examining BP in different settings have noted that average BP among hospitalized patients is not systematically higher than that of outpatients 12–14. Thus, patients with persistently elevated BP in the inpatient setting without mitigating factors may have HTN that will persist after hospital discharge.…”

Use of oral antihypertensive medication preceding blood pressure elevation in hospitalized patients

“…Individually, this blood pressure elevation is not a matter of using antihypertensive medication 1 . It is also important to observe that hypertensive patients experience a decrease in blood pressure after being admitted to the hospital regardless of the treatment [2][3][4][5] . In the last 2 decades, antihypertensive medications that act quickly after oral or sublingual administration [6][7][8][9][10][11][12] have been used.…”

Race Affects the Decline in Blood Pressure With Hospitalization

“…[13][14][15][16] This phenomenon appears to be related to diverse factors associated with hospitalization itself, including changes in sodium intake, habituation to the medical environment, and isolation from the stress and worries of the patient's regular environment. 13,14,16,17 Despite the literature on racial differences in BP, few if any studies have examined whether ethnicity influences this effect of hospitalization on BP.…”