The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association | Hypertension
Over the past 3 decades, a substantial body of high-quality evidence has guided the
diagnosis and management of elevated blood pressure (BP) in the outpatient setting.
In contrast, there is a lack of comparable evidence for guiding the management of
elevated BP in the acute care setting, resulting in significant practice variation.
Throughout this scientific statement, we use the terms acute care and inpatient to
refer to care received in the emergency department and after admission to the hospital.
Elevated inpatient BP is common and can manifest either as asymptomatic or with signs
of new or worsening target-organ damage, a condition referred to as hypertensive emergency.
Hypertensive emergency involves acute target-organ damage and should be treated swiftly,
usually with intravenous antihypertensive medications, in a closely monitored setting.
However, the risk-benefit ratio of initiating or intensifying antihypertensive medications
for asymptomatic elevated inpatient BP is less clear. Despite this ambiguity, clinicians
prescribe oral or intravenous antihypertensive medications in approximately one-third
of cases of asymptomatic elevated inpatient BP. Recent observational studies have
suggested potential harms associated with treating asymptomatic elevated inpatient
BP, which brings current practice into question. Despite the ubiquity of elevated
inpatient BPs, few position papers, guidelines, or consensus statements have focused
on improving BP management in the acute care setting. Therefore, this scientific statement
aims to synthesize the available evidence, provide suggestions for best practice based
on the available evidence, identify evidence-based gaps in managing elevated inpatient
BP (asymptomatic and hypertensive emergency), and highlight areas requiring further
research.
