Conservative Management Safer for Inpatient High BP

A US cohort study suggested that in the absence of evidence of end-organ damage, conservative management of inpatient high blood pressure (BP) was associated with improved outcomes compared with more intensive management. The study included 22 834 adults hospitalized for noncardiovascular diagnoses from January 1 to December 31, 2017 (mean age, 65.6 years; 56.9% women; 69.9% White), with 1 year of follow-up. A total of 17 821 (78%) had at least 1 high BP recorded during their admission, 33.1% were treated. A total of 8692 cases (8.2%) of high systolic BPs were treated; 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 (10.3% vs 7.9%) and myocardial injury (1.2% vs 0.6%). There was no BP interval in which treated patients had better outcomes than untreated patients. A total of 1645 patients (9%) with high BP were discharged with an intensified antihypertensive regimen. Medication intensification at discharge was not associated with better BP control in the following year. The findings suggest that high BP was common among inpatients, but antihypertensive treatment intensification was not, simply repeating the BP measurement several hours later may substitute for treatment. Even if intensification of therapy without signs of end-organ damage does not result in harm, there was no indication that it was beneficial. Source: https://jamanetwork.com/