Intensive Inpatient BP Management Not Beneficial in Seniors

WEDNESDAY, June 21, 2023 (HealthDay News) -- For hospitalized older adults with elevated blood pressure (BP), intensive antihypertensive treatment is associated with an increased risk for adverse events, according to a study published online May 30 in JAMA Internal Medicine.

Timothy S. Anderson, M.D., from Beth Israel Deaconess Medical Center in Boston, and colleagues conducted a retrospective cohort study involving patients aged 65 years or older hospitalized for noncardiovascular diagnoses and who experienced elevated BPs in the first 48 hours of hospitalization. Data were included for 66,140 patients, of whom 21.3 percent received intensive BP treatment in the first 48 hours of hospitalization.

The researchers found that compared with patients who did not receive early intensive treatment, those who received early intensive treatment continued to receive a greater number of additional antihypertensives during the remainder of their hospitalization (mean additional doses, 6.1 versus 1.6). Intensive treatment was associated with an increased risk for the primary composite outcome (inpatient mortality, intensive care unit transfer, stroke, acute kidney injury, B-type natriuretic peptide elevation, and troponin elevation; 8.7 versus 6.9 percent; weighted odds ratio, 1.28), with a greater risk seen for those receiving intravenous antihypertensives (weighted odds ratio, 1.90). The likelihood of experiencing each component of the composite outcome, except for stroke and mortality, was increased for intensively treated patients.

"Our findings do not support the pharmacologic treatment of elevated BPs without evidence of acute end organ damage in hospitalized older adults and highlight the need for adequately powered randomized clinical trials of BP treatment thresholds in the inpatient setting," the authors write.

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