Special guest Tim Anderson joins the hosts to discuss inpatient hypertension, focusing on patient outcomes, treatment methods, regional variations, and complexities of hypertension management. They explore challenges in clinical trials, analyzing IV and oral therapies, differentiation between SVT and sinus tachycardia, and navigating complexities in inpatient hypertension management. Book recommendations and discussions on sci-fi series and hiking adventures add a touch of entertainment to the podcast.
Intensive inpatient blood pressure treatment did not lead to significant clinical benefits compared to nonintensive treatment.
Patients who received intensive treatment had higher systolic blood pressures before admission and were more likely to have readings exceeding 180 within the first 48 hours.
Intensively treated patients consistently received a greater number of additional antihypertensives throughout their hospitalization, suggesting a prolonged pattern of treatment.
There was a higher risk of adverse outcomes like inpatient mortality and ICU transfer in the intensively treated group, despite reductions in systolic blood pressure.
Deep dives
Demographics and Baseline Characteristics
The study included 66,140 patients with a mean age of 74.4 years. 97.5% were males, and 75.9% were white. Patients who received intensive blood pressure treatment had higher systolic blood pressures before admission, with a mean of 140 compared to 135 for those who did not receive treatment.
Treatment and Medication Administration
21.3% of patients received intensive blood pressure treatment within the first 48 hours, involving IV antihypertensives or new classes of blood pressure medication. Among treated patients, 17.8% received IV antihypertensives during the initial treatment period. Intensively treated patients had higher systolic blood pressures prior to admission and were more likely to have blood pressure readings exceeding 180 within the first 48 hours.
Pattern of Treatment and Medication Continuation
Patients who received intensive treatment consistently received a greater number of additional antihypertensives throughout their hospitalization, averaging six doses compared to 1.6 for non-treated patients. Those who received IV antihypertensives in the early stage were more likely to continue receiving additional IV medications during the remainder of their hospital stay, with a mean of 1.4 doses compared to 0.1 for non-IV treated patients.
Effect of Treatment on Hospitalization
Intensive blood pressure treatment in the early phase led to a higher number of mean doses per day throughout the hospital stay, with 0.9 additional doses received per day compared to 0.3 for non-treated patients. Patients who initially received IV antihypertensives were more likely to receive additional IV medications, highlighting a continued pattern of treatment post-initial intervention.
Minimal Clinical Significance of Systolic Blood Pressure Reduction
The study highlighted that although there was a reduction in mean systolic blood pressure in the intensively treated group compared to the nonintensively treated group, this difference was deemed not clinically significant. The primary composite outcome, which included inpatient mortality, ICU transfer, and other health indicators, showed a greater risk in the intensively treated group.
Impact of Intensive Treatment on Various Outcomes
Patients in the intensively treated group displayed a higher risk of experiencing a primary composite outcome, such as inpatient mortality and ICU transfer, compared to those in the nonintensive treatment group. Despite the reduction in systolic blood pressure in the intensive group, the study suggested that intensive treatment did not lead to substantial clinical benefits.
Considerations for Blood Pressure Management in Hospitalized Patients
The discussion delved into the challenges of managing high blood pressure in hospitalized patients, emphasizing the need for contextual assessment and individualized care. The study raised questions on appropriate interventions and highlighted the importance of educating healthcare providers, including nurses, on when to evaluate and treat high blood pressure in inpatient settings.
The Jordy AC collab: An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback (PubMed)
Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge (PubMed)
Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008 to 2018 (PubMed)
