Top Things to Know: The Management of Elevated Blood Pressure in the Acute Care Setting
Published: May 28, 2024
- Although evidence-based clinical guidance is available for the diagnosis and management of elevated blood pressure in the outpatient setting, there is a lack of comparable evidence for the care of elevated blood pressure in the acute care setting (emergency department and hospital inpatient).
- Patients often present with elevated blood pressure in the acute care setting, either as ‘asymptomatic’ or without signs of new or worsening target organ damage, or with new or worsening target organ damage. The latter is often denoted ‘hypertensive emergency’, a condition which is usually treated with intravenous antihypertensive medication.
- While inpatient treatment for hypertensive emergencies is accepted, there is no clear consensus on the risk versus benefit of treating asymptomatic elevated blood pressure in the acute care setting.
- This scientific statement synthesizes the available evidence for managing elevated inpatient BP (asymptomatic and hypertensive emergency), offers suggestions for best practices, and identifies gaps and areas of focus for future research.
- Overall rates of hypertensive emergencies have increased in the US over the past twenty years while mortality has decreased. In 2012, hypertension was the primary diagnosis for over a million emergency department visits, with approximately 23% resulting in hospitalization.
- Certain patient populations appear more susceptible to hypertensive emergencies or asymptomatic inpatient elevated BP. Among these groups are older people, Black adults, and those with comorbidities such as diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD).
- There is also regional variation in the US in the prevalence of elevated inpatient BP. This is likely due to challenges such as shortages of health care professionals in rural areas and other resource availability unique to certain areas.
- Several barriers to identification and appropriate initiation of treatment in the ED persist, including diagnostic uncertainty regarding the reliability of BP measurement in the ED setting and lack of coordination with outpatient primary care teams.
- For many patients with high BP in the acute care setting, the difficulty is often the absence of consistent, high-quality, affordable, and reliable outpatient health care and follow-up rather. Filling this need may be more effective than initiating medication in the hospital.
- Currently, the recommendation based on best available evidence is for a practical, common-sense approach to treatment of asymptomatic elevated inpatient BP. This includes repeated BP measurement using proper measurement technique and addressing all underlying conditions rather than emphasizing mainly pharmacological interventions.
Citation
Bress AP, Anderson TS, Flack JM, Ghazi L, Hall ME, Laffer CL, Still CH, Taler SJ, Zachrison KS, Chang TI; on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. The management of elevated blood pressure in the acute care setting: ascientific statement from the American Heart Association. Hypertension. Published online May 28, 2024. doi: 10.1161/HYP.0000000000000238