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Asymptomatic hypertension in the hospital setting: primum non nocere

Journal of Human Hypertension volume 36, pages 781–784 (2022)Cite this article

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Asymptomatic in-hospital hypertension, defined as elevated blood pressure (i.e., systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) without acute evidence of end-organ damage, is a common scenario in hospital medicine [1]. Patients can be hospitalized for both cardiovascular and non-cardiovascular causes and subsequently develop asymptomatic hypertension of unclear clinical significance [1, 2]. Two recent reports suggest that the prevalence of asymptomatic in-hospital hypertension ranges from 50–78% and that clinicians treat with either oral or intravenous (IV) antihypertensive medication 33% of the time [3, 4]. Despite the high prevalence and treatment rates, data to guide clinicians on appropriate management of in-hospital asymptomatic hypertension are lacking [4]. Specifically, it is unclear if initiating and/or escalating antihypertensive medications to treat in-hospital asymptomatic hypertension is necessary or is doing more harm (i.e., medication-related adverse effects) than good (i.e., short-term cardiovascular benefit). Simply stated, clinicians need to know if and whom to treat, to what blood pressure goal, and how to reach that goal.

To address the first question—whom to treat—hypertensive patients can be roughly grouped into categories: asymptomatic hospitalized for non-cardiovascular reasons, asymptomatic hospitalized for cardiovascular diseases, and symptomatic patients hospitalized with hypertensive crisis or emergency. For the latter group, crisis or emergency (defined is blood pressure >180/120 mmHg with evidence of new or worsening end-organ damage), timely treatment is indicated and recommended in most situations [2]. Hypertensive crisis or emergency conditions should be treated with IV and oral antihypertensive medications according to current guidelines [5].

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Fig. 1: Algorithm for management of inpatient asymptomatic hypertension [1, 8].

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Authors and Affiliations

  1. Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA

    Joshua A. Jacobs & Adam P. Bress

  2. Department of Pharmacy, University of Utah, Salt Lake City, UT, USA

    Joshua A. Jacobs

  3. Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Rashmee U. Shah

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  1. Joshua A. Jacobs
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JAJ drafted the manuscript. APB and RUS were instrumental in editing, focusing, and preparing the manuscript.

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Correspondence to Joshua A. Jacobs.

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Jacobs, J.A., Shah, R.U. & Bress, A.P. Asymptomatic hypertension in the hospital setting: primum non nocere. J Hum Hypertens 36, 781–784 (2022). https://doi.org/10.1038/s41371-022-00676-y

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