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עברית
Neil H. Winawer, MD, SFHM, reviewing
Most likely not, especially not with intravenous antihypertensives.
In the absence of guidelines, whether to treat patients who develop substantially elevated blood pressure (BP) during hospitalization remains arbitrary. Researchers performed a retrospective cohort study of more than 200,000 non–critically ill adult inpatients (with diagnoses other than hypertensive emergency) at five teaching hospitals in Connecticut. Approximately 23,000 patients met criteria for severe hypertension (defined as systolic BP >180 mm Hg or diastolic BP >110 mm Hg), and 9000 of them received treatment: 21% received intravenous (IV) medications, 63% received oral medications, and 16% received both.
The primary outcome was mean arterial pressure drop of >30% — a measure of potential harm. In adjusted analysis of treated versus untreated patients, those who received only IV antihypertensive treatment were significantly more likely to have this potentially adverse outcome (hazard ratio, 1.4), and those who received only oral antihypertensive drugs were significantly less likely (HR, 0.7).
COMMENT
One take-home from the current study, consistent with others, is that use of IV antihypertensives in noncardiac inpatients without end organ damage should be discouraged. Elevated BP in hospitalized patients often is related to factors such as fluctuation in pain and agitation and falls spontaneously without treatment. The apparent benefit of oral antihypertensive agents seen in this study might be due to residual confounding and is antithetical to another recent large study, where treating inpatients who developed hypertension was associated with excess risk for acute kidney injury and myocardial infarction, with no benefit observed even at severe BP intervals (NEJM JW Gen Med Feb 15 2021 and JAMA Intern Med 2021; 181:345).