Blood Pressure Management in the Inpatient and Acute Care Setting

Abstract

Existing recommendations for blood pressure goals and treatment accumulated from decades of clinical trials and observational studies in which a resting blood pressure was measured in an outpatient setting and participants were followed for years. Consequently, existing guidelines for hypertension do not address day-to-day blood pressure control in an inpatient setting. When a patient is admitted, home blood pressure–lowering medications are often held, and the unfamiliar environment, clinical testing, and noise stress patients and heighten blood pressure. In this review, we describe the natural history of blood pressure changes during hospitalization and the reasons why blood pressure may increase in some patients. Due to lack of guidance, clinician management of elevated blood pressure among hospitalized patients varies widely, and we review observational studies that discuss outcomes with use of intravenous and/or oral blood pressure lowering medications to treat asymptomatic inpatient blood pressure elevations. Although clinical trials are needed for determining best practices, our review provides a suggested plan to address asymptomatic elevated blood pressure among patients hospitalized for noncardiovascular diseases.

Existing recommendations for blood pressure goals and treatment accumulated from decades of clinical trials and observational studies in which a resting blood pressure was measured in an outpatient setting and participants were followed for years. Consequently, existing guidelines for hypertension do not address day-to-day blood pressure control in an inpatient setting. When a patient is admitted, home blood pressure–lowering medications are often held, and the unfamiliar environment, clinical testing, and noise stress patients and heighten blood pressure. In this review, we describe the natural history of blood pressure changes during hospitalization and the reasons why blood pressure may increase in some patients. Due to lack of guidance, clinician management of elevated blood pressure among hospitalized patients varies widely, and we review observational studies that discuss outcomes with use of intravenous and/or oral blood pressure lowering medications to treat asymptomatic inpatient blood pressure elevations. Although clinical trials are needed for determining best practices, our review provides a suggested plan to address asymptomatic elevated blood pressure among patients hospitalized for noncardiovascular diseases.