Management of asymptomatic hypertension linked to increased risk of heart, kidney injury: Study

In hospitalized patients, blood pressure is regularly monitored. Severe high blood pressure can lead to heart attack, stroke, or damage to blood arteries and organs such as the heart, brain, kidneys, and eyes. On the other hand, most hospitalized people have transiently elevated blood pressure without evidence of organ damage, which is known as silent hypertension and is sometimes treated with blood pressure medications. However, there is little data to guide such medical decisions.

In a retrospective cohort study, physician-researchers from Beth Israel Deaconess Medical Center (BIDMC) examined the treatment of elevated blood pressure in more than 66,000 older adults who were hospitalized for non-cardiac conditions. The team found that receiving intensive antihypertensive treatment as an inpatient was associated with a greater risk of adverse events, particularly for patients taking the drug orally.

The findings, published in JAMA Internal Medicine, do not support treatment of asymptomatic hypertension in hospitalized older adults and highlight the need for further study of best practices for the management of inpatient blood pressure.

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Corresponding author Timothy S. “The benefits of lowering chronically elevated blood pressure in the outpatient setting are clearly defined and include reductions in mortality and cardiovascular events, for clinical decision-making,” said Anderson. Better evidence is needed.” , MD, MAS, a clinical investigator in the Department of General Medicine at BIDMC.

“In the hospital, blood pressure is often elevated due to pain, fever, anxiety, new medication, and other hospital factors. It is unclear whether treating transient elevations with blood pressure medications is helpful, instead resulting in overtreatment.” It is possible.”

Using clinical and pharmacy data from the National Veterans Health Administration (VHA), Anderson and colleagues compared outcomes for hospitalized patients with high blood pressure who did not receive intensive blood pressure treatment in the first 48 hours after admission. . The primary outcome was a composite of adverse effects including inpatient mortality, acute kidney injury, cardiac injury, stroke, and transfer to the intensive care unit.

The group included 66,140 older adults, primarily men, who were hospitalized for non-cardiac causes and had elevated blood pressure within the first 48 hours of hospitalization. One in five patients (or more than 14,000 patients) received intensive treatment for blood pressure, defined as additional antihypertensive medications that the patient was not taking at home prior to hospitalization. Of this group, 18 percent (or more than 2,500 patients) were given antihypertensive medication intravenously.

Compared with hospitalized patients with hypertension who did not receive intensive treatment within the first 48 hours of hospitalization, patients who received antihypertensive drugs were more likely to experience adverse clinical events, including cardiac injury, acute kidney injury, and ICU transfer. There was a high risk of consequences. Receiving antihypertensives increases intravenous risk.

“These findings suggest that rapid treatment of asymptomatic patient blood pressure may be harmful and that the use of intravenous antihypertensives in particular should be discouraged,” said Anderson, assistant professor of medicine at Harvard Medical School.

“Until we have more definitive randomized clinical trial data, our findings suggest that the safest route forward is likely to be to reconsider the underlying cause of patient blood pressure measurement and re-orient clinical practice. In combination , These findings suggest that pharmacological treatment of asymptomatic advanced patient blood pressure should be the exception rather than the rule.”