Annals for Hospitalists Inpatient Notes - Inpatient Hypertension—To Treat or Tolerate?
Authors: Timothy S. Anderson, Charlie M. Wray
Journal: Annals of Internal Medicine (2020)

Web Exclusives21 April 2020Annals for Hospitalists Inpatient Notes - Inpatient Hypertension—To Treat or Tolerate?Timothy S. Anderson, MD, MAS and Charlie M. Wray, DO, MSTimothy S. Anderson, MD, MASBeth Israel Deaconess Medical Center and Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts (T.S.A.) and Charlie M. Wray, DO, MSUniversity of California San Francisco and San Francisco Veteran Affairs Medical Center, San Francisco, California (C.M.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-1021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Elevated blood pressures (BPs) are a pervasive problem among hospitalized patients. Although substantial evidence exists for active BP management in patients who have evidence of end-organ damage (that is, hypertensive emergency), there is a paucity of guidance on how inpatient providers should manage patients with hypertensive urgency (systolic BP >180 mm Hg without evidence of end-organ damage) or moderately elevated BP (systolic BP of 150 to 180 mm Hg) during hospitalization.When faced with other vital sign abnormalities (for example, tachycardia, fever, or hypotension), hospitalists are taught to assess for underlying drivers of these abnormalities and think critically about their ...References1. Breu AC, Axon RN. Acute treatment of hypertensive urgency. J Hosp Med. 2018;13:860-862. [PMID: 30379139] doi:10.12788/jhm.3086 CrossrefMedlineGoogle Scholar2. Gaynor MF, Wright GC, Vondracek S. Retrospective review of the use of as-needed hydralazine and labetalol for the treatment of acute hypertension in hospitalized medicine patients. Ther Adv Cardiovasc Dis. 2018;12:7-15. [PMID: 29265003] doi:10.1177/1753944717746613 CrossrefMedlineGoogle Scholar3. Anderson TS, Wray CM, Jing B, et al. Intensification of older adults' outpatient blood pressure treatment at hospital discharge: national retrospective cohort study. BMJ. 2018;362:k3503. [PMID: 30209052] doi:10.1136/bmj.k3503 CrossrefMedlineGoogle Scholar4. Anderson TS, Jing B, Auerbach A, et al. Clinical outcomes after intensifying antihypertensive medication regimens among older adults at hospital discharge. JAMA Intern Med. 2019. [PMID: 31424475] doi:10.1001/jamainternmed.2019.3007 CrossrefMedlineGoogle Scholar5. Coleman EA, Smith JD, Raha D, et al. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165:1842-7. [PMID: 16157827] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Beth Israel Deaconess Medical Center and Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts (T.S.A.)University of California San Francisco and San Francisco Veteran Affairs Medical Center, San Francisco, California (C.M.W.)Grant Support: Dr. Anderson was supported by grants from the National Institute on Aging (L30AG060493 and R03AG064373) and American College of Cardiology related to this work.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1021.Corresponding Author: Timothy S. Anderson, MD, MAS, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA 02446; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Anderson: Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA 02446.Dr. Wray: University of California at San Francisco, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 21 April 2020 David H. Wesorick and Vineet Chopra Annals On Call - Hypertension in the Hospital Robert M. Centor , Timothy S. Anderson , and Charlie M. Wray Metrics Cited byOlder Adults' Persistence to Antihypertensives Prescribed at Hospital Discharge: a Retrospective Cohort StudyThe Story of the Silent Killer 21 April 2020Volume 172, Issue 8Page: HO2-HO3KeywordsBlood pressureDecision makingDisclosureElectronic medical recordsHospitalistsHospitalizationsInpatientsLife expectancyOutpatientsVeteran care ePublished: 21 April 2020 Issue Published: 21 April 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...