Background:
High Wood pressure (BP) is frequently treated in patients hospitalized for reasons other than hypertension, but there are no evidence based guidelines for the management of asymptomatic high BP not associated with target organ damage in the hospital.
Methods:
We conducted an online survey to assess the beliefs and practices of hospilalists at the University of Michigan regarding the treatment of elevated BP in the inpatient setting.
Results:
Of the 31 hospitalists who completed the survey, 67.7% believed that adjusting medications to treat acutely increased BP in the hospital was not important or believed neutral regarding the issue; however, 89.7% believed That there are levels of BP for which the adjustment of antihypertensive medications is appropriate, even in the absence of acute cardiac, vascular, or renal damage. The average systolic BP to adjust antihypertensive medications without evidence of cardiac, vascular, or renal damage was 173.85 (35.45). The majority polled (51.6%) typically used blood pressures obtained by someone else to make treatment decisions, and 67.7% polled rechecked blood pressure < 20% of the time. Of those polled, 67.7% would not transfer an asymptomatic hypertensive patient to an ICU for further management: however, 71.0% would delay or cancel discharge because of elevated BP without evidence of end‐organ damage. The average systolic BP to delay or cancel discharge was 191.36 (13.56). The majority polled (83.9%) believed thai fewer than 40% of patients treated for elevated BP but admitted for other medical reasons were discharged on a different antihypertensive regimen than that established prior to admission. Finally, 83.9% would consider consulting another physician with expertise in the field of hypertension regarding treatment of hypertension in an inpatient.
Conclusions:
Hospitalists at our hospital routinely manage elevated BP in patients admitted for other medical reasons. The majority believed there are levels of BP for which the adjustment of antihypertensive medications is appropriate, even in the absence of acute cardiac, vascular, or renal damage. It appears that their beliefs about what constitutes a dangerous level of BP are reasonably consistent, even though their practices are not supported by any evidence or expert recommendations. It also appears that elevated BP in patients without end‐organ damage can frequently delay or cancel patient discharge, which may represent inappropriate use of hospital resources. According to the majority of physicians polled, the practice of discharging patients on a drug regimen that was altered during a hospitalization as opposed to that which had been in place prior to admission occurred less than 40% of the time and is poorly justified. These data strongly suggest the need for the development of guidelines for the management of asymptomatic high BP in the inpatient setting.
Author Disclosure:
K. Pfahl, none; A. Weder, none; W. Repaskey, none.