SHM's Clinical Quick Talks-Hypertension in Hospitalized Patients

Pdf Summary

The document titled "Hypertension in Hospitalized Patients" by Vinay Choksi, MD, primarily focuses on differentiating between hypertensive urgency and hypertensive emergency, along with understanding treatment goals for hospitalized patients with hypertension.

<strong>Key Definitions:</strong>
- <strong>Hypertension:</strong> Elevated blood pressure, defined as 130/80 mmHg or higher, based on outpatient guidelines.
- <strong>Hypertensive Urgency:</strong> Blood pressure of 180/120 mmHg or higher without end-organ damage. It is suggested to consider re-evaluation and restarting home medications without immediate intensive treatment.
- <strong>Hypertensive Emergency:</strong> Blood pressure of 180/120 mmHg or higher with end-organ damage, requiring urgent management, potentially in an ICU setting.

<strong>Management Guidelines:</strong>

1. <strong>Hypertensive Urgency:</strong> 
   - Recheck BP after rest.
   - Restart home medications if applicable, addressing contributing factors like stress or medication withdrawal.
   - Avoid intensifying medication regimens if admitted for non-cardiac causes.

2. <strong>Hypertensive Emergency:</strong>
   - Initial goal: Reduce BP by no more than 20% in the first hour, followed by a gradual reduction to around 160/110 mmHg over the next 23 hours.
   - Exceptions for acute ischemic stroke, aortic dissection, and intracerebral hemorrhage, with specific treatment strategies and titratable IV medications suggested.

<strong>Clinical Pearls:</strong>
- Clearly ascertain end-organ damage for hypertensive emergencies.
- Avoid unnecessary blood pressure treatments for patients with high BP but lacking symptoms or end-organ damage.
- Exercise caution in medication changes for patients hospitalized for non-cardiac reasons.

<strong>High-Value Resources:</strong>
- References include the 2017 ACC/AHA Hypertension Guidelines and several key articles on acute severe hypertension and antihypertensive medication management upon hospital discharge.

Asset Subtitle

Vinay Choski

Keywords

hypertension

hypertensive urgency

hypertensive emergency

blood pressure

end-organ damage

treatment goals

hospitalized patients

medication management

ICU setting

ACC/AHA guidelines