Hypertension ‘common’ among hospitalized patients, but few receive treatment

Although elevated BP was “common” among hospitalized patients within Cleveland Clinic’s health system, “antihypertensive treatment intensification was not,” authors of a cohort study in JAMA Internal Medicine wrote.

However, the researchers also found that co-occurrence of treatment intensification and no signs of end-organ damage was associated with worse patient outcomes.

“Paradoxically, treatment, which presumably was meant to prevent end-organ damage, was associated with higher rates of [acute kidney injury] and myocardial injury. In fact, we found no benefit associated with any treatment route or at any BP interval,” Radhika Rastogi, MD, MPH, a pediatric resident at Children's Hospital of Philadelphia, and colleagues wrote. “Our findings suggest that hypertension among medical inpatients should be managed conservatively.”

The researchers analyzed 22,834 adults hospitalized for noncardiovascular diagnoses and followed them for 1 year. The mean age of the patients was 65.6 years; 69.9% were white; and 56.9% were women.

Rastogi and colleagues found that 78% of the patients that had at least one hypertensive BP reading during their hospital stay, but just 33.1% were treated for that condition. Only 8.2% of 106,097 hypertensive systolic BP cases were treated, and of these, 66% received oral medications.

In what researchers deemed the first propensity-matched sample controlling for patient and BP characteristics, they found that the treated patients had higher rates of subsequent acute kidney injury (10.3% vs. 7.9%; P < .001) and myocardial injury (1.2% vs. 0.6%; P = .003) than untreated patients; the incidence of stroke among hospitalized patients was “extremely rare” (0.1% vs. 0.1%).

There was no BP interval in which treated patients had better outcomes than untreated patients, according to the researchers. Only 9% of 17,821 patients with hypertension were discharged with an intensified antihypertensive regimen; however, medication intensification was not associated with better BP control in the year following discharge.

“Our study adds to the evidence suggesting harms associated with treating inpatient hypertension,” Rastogi and colleagues wrote. “Our finding that the harms associated with treatment persist into higher intervals of BP, even those categorized as hypertensive urgency, strengthens the case for conservative management. However, that the majority of treated patients received only oral antihypertensives — also associated with harm — suggests a need to reduce oral antihypertensives as well.”