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‘7 easy steps’ to treat inpatient elevated BP

PHILADELPHIA — Inpatient elevated BP management is often overlooked in hospital settings, a speaker at the American College of Physicians Internal Medicine Meeting said.

“Research shows that about 87% of patients with previously documented hypertension were uncontrolled on admission. ... Of those, 37% to 77% had uncontrolled hypertension of greater than 140 mm Hg/90 mm Hg at discharge,” R. Neal Axon, MD, MSCR, associate professor at the College of Medicine at the Medical University of South Carolina, told attendees.

He recommended the following checklist that consists of “seven easy steps” to help these patients with elevated high BP:

• Manage the condition as a potential hypertensive emergency if the patient has end organ damage and/or symptoms such as chest pain, focal neuro findings, mental status changes or dyspnea.
• Treat nausea, pain, anxiety or other symptoms first before adding or titrating BP medications.
• Remember that patients withdrawing from illicit drugs, alcohol or benzodiazepines frequently have much higher BP than those who are not on these substances.
• Treat volume overload by stopping IV fluids and/or diuretics and utilize the opposite approach if volume depletion is present.
• Adjust the patient’s medication list accordingly if he or she is taking medications such as NSAIDs that contribute to hypertension.
• Resume home BP medications if indicated.
• Contemplate titrating or adding BP medications in coordination with a primary care physician if the BP is still elevated after steps one through six.

Lack of communication between medical professionals helping patients with elevated BP presents an opportunity for improvement, Axon said.

“As hospitalists, we can have a narrow view of the world if we allow ourselves to. We need to remember PCPs may have had a very good reason for starting part of a patient’s medication regimen,” he said.

“I did a study a few years ago where we gave clinical scenarios to residents in family medicine or internal medicine with patients who had heart failure in an inpatient setting. Only 3% of residents said they coordinated medications with the patient’s primary care doctor as the patient moved to an outpatient setting. Clearly, we have an opportunity to do better than that,” Axon concluded. – by Janel Miller

Reference: Axon RN. “Hypertension management of the inpatient: When high isn't a good thing.” Presented at: ACP Internal Medicine Meeting; April 11-13, 2019; Philadelphia.

Disclosure s : Axon reports no relevant financial disclosures.