Skip to main content
Top
Published in: Current Cardiology Reports 7/2022

Open Access 07-05-2022 | Hypertensive Emergency | Ischemic Heart Disease (D Mukherjee, Section Editor)

Treatment of Hypertension Among Non-Cardiac Hospitalized Patients

Authors: Bhanu Chaganti, Richard A. Lange

Published in: Current Cardiology Reports | Issue 7/2022

Login to get access

Abstract

Purpose of Review

This review provides a contemporary perspective and approach for the treatment of hypertension (HTN) among patients hospitalized for non-cardiac reasons.

Recent Findings

Elevated blood pressure (BP) is a common dilemma encountered by physicians, but guidelines are lacking to assist providers in managing hospitalized patients with elevated BP. Inpatient HTN is common, and management remains challenging given the paucity of data and misperceptions among training and practicing physicians. The outcomes associated with intensifying BP treatment during hospitalization can be harmful, with little to no long-term benefits. Data also suggests that medication intensification at discharge is not associated with improved outpatient BP control.

Summary

Routine inpatient HTN control in the absence of end-organ damage has not shown to be helpful and may have deleterious effects. Since routine use of intravenous antihypertensives in hospitalized non-cardiac patients has been shown to prolong inpatient stay without benefits, their routine use should be avoided for inpatient HTN control. Future large-scale trials measuring clinical outcomes during prolonged follow-up may help to identify specific circumstances where inpatient HTN control may be beneficial.
Literature
1.
go back to reference Axon R, Neal LC, Egan BM. Prevalence and management of hypertension in the inpatient setting: a systematic review. J Hosp Med. 2011;6(7):417–22.CrossRef Axon R, Neal LC, Egan BM. Prevalence and management of hypertension in the inpatient setting: a systematic review. J Hosp Med. 2011;6(7):417–22.CrossRef
2.
go back to reference Conen D, Martina B, Perruchoud AP, Leimenstoll BM. High prevalence of newly detected hypertension in hospitalized patients: the value of inhospital 24-h blood pressure measurement. J Hypertens. 2006;24(2):301–6.CrossRef Conen D, Martina B, Perruchoud AP, Leimenstoll BM. High prevalence of newly detected hypertension in hospitalized patients: the value of inhospital 24-h blood pressure measurement. J Hypertens. 2006;24(2):301–6.CrossRef
3.
go back to reference Whelton PK, Williams B. The 2018 European Society of Cardiology/European Society of Hypertension and 2017 American College of Cardiology/American Heart Association blood pressure guidelines: more similar than different. JAMA. 2018;320(17):1749–50.CrossRef Whelton PK, Williams B. The 2018 European Society of Cardiology/European Society of Hypertension and 2017 American College of Cardiology/American Heart Association blood pressure guidelines: more similar than different. JAMA. 2018;320(17):1749–50.CrossRef
4.
go back to reference Neal AR, Garrell R, Pfahl K, Fisher JE, Zhao Y, Egan B, et al. Attitudes and practices of resident physicians regarding hypertension in the inpatient setting. J Clin Hypertens. 2010;12(9):698–705. Neal AR, Garrell R, Pfahl K, Fisher JE, Zhao Y, Egan B, et al. Attitudes and practices of resident physicians regarding hypertension in the inpatient setting. J Clin Hypertens. 2010;12(9):698–705.
5.
go back to reference Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957–67.CrossRef Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957–67.CrossRef
6.
go back to reference Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and meta-regression analyses of randomized trials. J Hypertens. 2014;32(12):2285–95. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and meta-regression analyses of randomized trials. J Hypertens. 2014;32(12):2285–95.
7.
go back to reference Armitage LC, Mahdi A, Lawson BK, Roman C, Fanshawe T, Tarassenko L, et al. Screening for hypertension in the inpatient environment (SHINE): a protocol for a prospective study of diagnostic accuracy among adult hospital patients. BMJ Open. 2019;9(12): e033792.CrossRef Armitage LC, Mahdi A, Lawson BK, Roman C, Fanshawe T, Tarassenko L, et al. Screening for hypertension in the inpatient environment (SHINE): a protocol for a prospective study of diagnostic accuracy among adult hospital patients. BMJ Open. 2019;9(12): e033792.CrossRef
8.
go back to reference Shankar BS, Russell RP, Southard JW, Schurman EW. Patterns of care for hypertension among hospitalized patients. Public Health Rep. 1982;97(6):521.PubMedPubMedCentral Shankar BS, Russell RP, Southard JW, Schurman EW. Patterns of care for hypertension among hospitalized patients. Public Health Rep. 1982;97(6):521.PubMedPubMedCentral
10.
go back to reference Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104.CrossRef Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104.CrossRef
11.
go back to reference Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. JACC. 2018;71(19):e127-248.CrossRef Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. JACC. 2018;71(19):e127-248.CrossRef
12.
go back to reference EUROASPIRE Study Group. EUROASPIRE : a European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. Eur Heart J. 1997;18(10):1569–82.CrossRef EUROASPIRE Study Group. EUROASPIRE : a European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. Eur Heart J. 1997;18(10):1569–82.CrossRef
13.
go back to reference Euroaspire I. Lifestyle and risk-factor management and use of drug therapies in coronary patients from 15 countries. Eur Heart J. 2001;22(7):554–72.CrossRef Euroaspire I. Lifestyle and risk-factor management and use of drug therapies in coronary patients from 15 countries. Eur Heart J. 2001;22(7):554–72.CrossRef
14.
go back to reference Jankowski P, Kawecka-Jaszcz K, Bilo G, Pająk A. Determinants of poor hypertension management in patients with ischaemic heart disease. Blood Press. 2005;14(5):284–92.CrossRef Jankowski P, Kawecka-Jaszcz K, Bilo G, Pająk A. Determinants of poor hypertension management in patients with ischaemic heart disease. Blood Press. 2005;14(5):284–92.CrossRef
15.
go back to reference Kotseva K, Wood D, Backer GD, Bacquer DD, Pyörälä K, Keil U, et al. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16(2):121–37. Kotseva K, Wood D, Backer GD, Bacquer DD, Pyörälä K, Keil U, et al. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16(2):121–37.
16.
go back to reference Zanuzzi MG, Álvarez JI, Garay SB, Peñaranda GE, Romero CA. Inpatient hypertension predicts ambulatory hypertension in previously normotensive patients. J Hypertens. 2021;1(39):e244–5.CrossRef Zanuzzi MG, Álvarez JI, Garay SB, Peñaranda GE, Romero CA. Inpatient hypertension predicts ambulatory hypertension in previously normotensive patients. J Hypertens. 2021;1(39):e244–5.CrossRef
17.
go back to reference Weder AB. Treating acute hypertension in the hospital: a lacuna in the guidelines. Hypertens. 2011;57(1):18–20.CrossRef Weder AB. Treating acute hypertension in the hospital: a lacuna in the guidelines. Hypertens. 2011;57(1):18–20.CrossRef
18.
go back to reference Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, et al. Hypertension Canada’s 2016 Canadian hypertension education program guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2016;32(5):569–88.CrossRef Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, et al. Hypertension Canada’s 2016 Canadian hypertension education program guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2016;32(5):569–88.CrossRef
19.
go back to reference Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018;34(5):506–25.CrossRef Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018;34(5):506–25.CrossRef
20.
go back to reference •• Rastogi R, Sheehan MM, Hu B, Shaker V, Kojima L, Rothberg MB. Treatment and outcomes of inpatient hypertension among adults with noncardiac admissions. JAMA Int Med. 2021;181(3):345–52. Only large-scale retrospective trial comparing inpatient hypertension outcomes in non-cardiac admissions. •• Rastogi R, Sheehan MM, Hu B, Shaker V, Kojima L, Rothberg MB. Treatment and outcomes of inpatient hypertension among adults with noncardiac admissions. JAMA Int Med. 2021;181(3):345–52. Only large-scale retrospective trial comparing inpatient hypertension outcomes in non-cardiac admissions.
21.
go back to reference Weder AB, Erickson S. Treatment of hypertension in the inpatient setting: use of intravenous labetalol and hydralazine. J Clin Hypertens. 2010;12(1):29–33.CrossRef Weder AB, Erickson S. Treatment of hypertension in the inpatient setting: use of intravenous labetalol and hydralazine. J Clin Hypertens. 2010;12(1):29–33.CrossRef
22.
go back to reference • Bean-Thompson K, Exposito J, Fowler O, Mhaskar R, Chen L, Codolosa JN. Impact of intravenous antihypertensives on outcomes among hospitalized patients. Am J Hyperten. 2021;34(8):867–73. A study showing effects of IV as-needed (PRN) antihypertensives on prolonged hospital stay and mortality. • Bean-Thompson K, Exposito J, Fowler O, Mhaskar R, Chen L, Codolosa JN. Impact of intravenous antihypertensives on outcomes among hospitalized patients. Am J Hyperten. 2021;34(8):867–73. A study showing effects of IV as-needed (PRN) antihypertensives on prolonged hospital stay and mortality.
23.
go back to reference Decker WW, Godwin SA, Hess EP, Lenamond CC, Jagoda AS. Clinical policy: critical issues in the evaluation and management of adult patients with asymptomatic hypertension in the emergency department. Ann Emerg Med. 2006;47(3):237–49.CrossRef Decker WW, Godwin SA, Hess EP, Lenamond CC, Jagoda AS. Clinical policy: critical issues in the evaluation and management of adult patients with asymptomatic hypertension in the emergency department. Ann Emerg Med. 2006;47(3):237–49.CrossRef
24.
go back to reference •• Anderson TS, Jing B, Auerbach A, Wray CM, Lee S, Boscardin WJ, et al. Clinical outcomes after intensifying antihypertensive medication regimens among older adults at hospital discharge. JAMA Int Med. 2019;179(11):1528–36. A study demonstrating outcomes after intensification of HTN regimen. •• Anderson TS, Jing B, Auerbach A, Wray CM, Lee S, Boscardin WJ, et al. Clinical outcomes after intensifying antihypertensive medication regimens among older adults at hospital discharge. JAMA Int Med. 2019;179(11):1528–36. A study demonstrating outcomes after intensification of HTN regimen.
25.
go back to reference Veterans Administration Co-operative Study Group on Antihypertensive agents: Effects of treatment on morbidity in hypertension. I. Results in patients with diastolic blood pressure averaging 115 through 129mm Hg. JAMA. 1967;202:1028–34. Veterans Administration Co-operative Study Group on Antihypertensive agents: Effects of treatment on morbidity in hypertension. I. Results in patients with diastolic blood pressure averaging 115 through 129mm Hg. JAMA. 1967;202:1028–34.
26.
go back to reference Brooks TW, Finch CK, Lobo BL, Deaton PR, Varner CF. Blood pressure management in acute hypertensive emergency. Am J Health Syst Pharm. 2007;64(24):2579–82.CrossRef Brooks TW, Finch CK, Lobo BL, Deaton PR, Varner CF. Blood pressure management in acute hypertensive emergency. Am J Health Syst Pharm. 2007;64(24):2579–82.CrossRef
27.
go back to reference Fischberg GM, Lozano E, Rajamani K, Ameriso S, Fisher MJ. Stroke precipitated by moderate blood pressure J Emerg Med. 2000;19(4):339–46.PubMed Fischberg GM, Lozano E, Rajamani K, Ameriso S, Fisher MJ. Stroke precipitated by moderate blood pressure J Emerg Med. 2000;19(4):339–46.PubMed
28.
go back to reference Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996;276(16):1328–31.CrossRef Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996;276(16):1328–31.CrossRef
29.
go back to reference Hodsman GP, Isles CG, Murray GD, Usherwood TP, Webb DJ, Robertson JI. Factors related to first dose hypotensive effect of captopril: prediction and treatment. Br Med J (Clin Res Ed). 1983;286(6368):832–4.CrossRef Hodsman GP, Isles CG, Murray GD, Usherwood TP, Webb DJ, Robertson JI. Factors related to first dose hypotensive effect of captopril: prediction and treatment. Br Med J (Clin Res Ed). 1983;286(6368):832–4.CrossRef
30.
go back to reference Zeller KR, Von Kuhnert L, Matthews C. Rapid reduction of severe asymptomatic hypertension: a prospective, controlled trial. Arch Int Med. 1989;149(10):2186–9.CrossRef Zeller KR, Von Kuhnert L, Matthews C. Rapid reduction of severe asymptomatic hypertension: a prospective, controlled trial. Arch Int Med. 1989;149(10):2186–9.CrossRef
31.
go back to reference • Axon RN, Turner M, Buckley R. An update on inpatient hypertension management. Curr Cardiol Rep. 2015;17(11):1–8. An article suggesting a practical approach to inpatient HTN management. • Axon RN, Turner M, Buckley R. An update on inpatient hypertension management. Curr Cardiol Rep. 2015;17(11):1–8. An article suggesting a practical approach to inpatient HTN management.
32.
go back to reference Group IS. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. Lancet. 1997;349(9065):1569–81.CrossRef Group IS. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. Lancet. 1997;349(9065):1569–81.CrossRef
33.
go back to reference Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke. 2009;40(3):994–1025.CrossRef Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke. 2009;40(3):994–1025.CrossRef
34.
go back to reference Blecker S, Meisel T, Dickson VV, Shelley D, Horwitz LI. “We’re almost guests in their clinical care”: Inpatient provider attitudes toward chronic disease management. J Hosp Med. 2017;12(3):162.CrossRef Blecker S, Meisel T, Dickson VV, Shelley D, Horwitz LI. “We’re almost guests in their clinical care”: Inpatient provider attitudes toward chronic disease management. J Hosp Med. 2017;12(3):162.CrossRef
35.
go back to reference Soto-Ruiz KM, Peacock WF, Varon J. Perioperative hypertension: diagnosis and treatment. Neth J Crit Care. 2011;15(3):143–8.CrossRef Soto-Ruiz KM, Peacock WF, Varon J. Perioperative hypertension: diagnosis and treatment. Neth J Crit Care. 2011;15(3):143–8.CrossRef
36.
go back to reference Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag. 2008;4(3):615.CrossRef Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag. 2008;4(3):615.CrossRef
37.
go back to reference Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345–9.PubMedPubMedCentral Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345–9.PubMedPubMedCentral
38.
go back to reference Steinman MA, Auerbach AD. Managing chronic disease in hospitalized patients. JAMA Int Med. 2013;173(20):1857–8.CrossRef Steinman MA, Auerbach AD. Managing chronic disease in hospitalized patients. JAMA Int Med. 2013;173(20):1857–8.CrossRef
39.
go back to reference • Anderson TS, Wray CM, Jing B, Fung K, Ngo S, Xu E, et al. Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study. BMJ. 2018;362. A large-scale study showing outcomes after inpatient intensification of HTN therapy. • Anderson TS, Wray CM, Jing B, Fung K, Ngo S, Xu E, et al. Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study. BMJ. 2018;362. A large-scale study showing outcomes after inpatient intensification of HTN therapy.
40.
go back to reference Mansur N, Weiss A, Beloosesky Y. Relationship of in-hospital medication modifications of elderly patients to post discharge medications, adherence, and mortality. Ann Pharmacother. 2008;42(6):783–9.CrossRef Mansur N, Weiss A, Beloosesky Y. Relationship of in-hospital medication modifications of elderly patients to post discharge medications, adherence, and mortality. Ann Pharmacother. 2008;42(6):783–9.CrossRef
41.
go back to reference Shimbo D, Barrett Bowling C, Levitan EB, Deng L, Sim JJ, Huang L, et al. Short-term risk of serious fall injuries in older adults initiating and intensifying treatment with antihypertensive medication. Circ Cardiovasc Qual Outcomes. 2016;9(3):222–9.CrossRef Shimbo D, Barrett Bowling C, Levitan EB, Deng L, Sim JJ, Huang L, et al. Short-term risk of serious fall injuries in older adults initiating and intensifying treatment with antihypertensive medication. Circ Cardiovasc Qual Outcomes. 2016;9(3):222–9.CrossRef
42.
go back to reference Kwan JL, Lo L, Sampson M, Shojania KG. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Annals of internal medicine. 2013;158(5_Part_2):397–403. Kwan JL, Lo L, Sampson M, Shojania KG. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Annals of internal medicine. 2013;158(5_Part_2):397–403.
Metadata
Title
Treatment of Hypertension Among Non-Cardiac Hospitalized Patients
Authors
Bhanu Chaganti
Richard A. Lange
Publication date
07-05-2022
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 7/2022
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-022-01699-0

Other articles of this Issue 7/2022

Current Cardiology Reports 7/2022 Go to the issue

New Therapies for Cardiovascular Disease (AA Bavry and M Massoomi, Section Editors)

Pulsed Field Ablation: a Novel Therapeutic Tool for Catheter-Based Treatment of Atrial Fibrillation

Women and Cardiovascular Health (N Goldberg and S Lewis, Section Editors)

Assessment of Cardiac Risk in Women with Autoimmune Disease

Interventional Cardiology (SR Bailey and T Helmy, Section Editors)

Safety and Efficacy of Robotic-Assisted PCI

Myocardial Disease (A Abbate and M Merlo, Section Editor)

Imaging-Guided Treatment for Cardiac Amyloidosis

Management of Acute Coronary Syndromes (H Jneid, Section Editor)

Readmission After ACS: Burden, Epidemiology, and Mitigation

Nuclear Cardiology (V Dilsizian, Section Editor)

Alternative Nuclear Imaging Tools for Infection Imaging