Guidance Lacking for Inpatient Management of Asymptomatic HTN

WEDNESDAY, April 3, 2024 (HealthDay News) — Guidance on inpatient management of elevated blood pressure (BP) without symptoms is lacking, according to a review published online April 2 in the Annals of Internal Medicine.

Linnea M. Wilson, M.P.H., from the Beth Israel Deaconess Medical Center in Boston, and colleagues conducted a systematic review to identify clinical practice guidelines pertaining to BP management in the hospital for adult and older adult populations.

Fourteen guidelines met the inclusion criteria: 11 provided broad recommendations for BP management, and one each was specific to the emergency department setting, older adults, and hypertensive crises. The researchers found that none of the guidelines provided goals for inpatient BP or recommendations for management of inpatient asymptomatic moderately elevated BP. Hypertensive urgency was defined as BP greater than 180/120 mm Hg in six guidelines, with the addition of target organ damage defining hypertensive emergencies. Recommendations consistently included use of intravenous antihypertensives in intensive care settings for hypertensive emergencies. Inconsistent recommendations were seen for managing hypertensive urgencies, and these focused on the emergency department. Outpatient BP goals were clearly defined and ranged from 130/80 to 140/90 mm Hg.

“There is an urgent need for pragmatic clinical trials to fill knowledge gaps for the management of elevated BP in hospitalized adults as well as a need for the development of inpatient BP clinical decision-making frameworks that address the unique issues posed by hospitalization and care transitions,” the authors write.

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