INHOSPITAL DETECTION OF ELEVATED BLOOD PRESSURE (INDEBP): PRELIMINARY RESULTS OF A RETROSPECTIVE ANALYSIS

Abstract

Objective: Elevated blood pressure (BP) values are commonly reported in hospitalized patients. Previous retrospective studies have shown that adaptions of BP medication are associated with a worse outcome. Objective of this study was to analyze the prevalence of elevated BP values in medical non-cardiac inpatients and to assess the proportion of patients with treatment modifications in response to elevated BP values during the hospital stay. Design and method: Retrospective analysis of randomly selected non-cardiac medical inpatients in a tertiary hospital in 2019 and 2021. Exclusion criteria were cardio-vascular hospitalization, missing general consent or age <18 years. Routine BP measurements from clinical checks were recorded, elevated BP defined as > = 140 and/or > = 90 mmHg. Antihypertensive treatment at admission was compared to that at discharge. Complications during hospitalization were a compound of myocardial injury, intracerebral bleedings, ischemic stroke/TIA, acute kidney injury, falls/syncope and death. Data were extracted from electronic health records. Categorical data was analyzed with a Fisher's exact test, continuous data with a Mann-Whitney-U-test. Results: 301 patients were included, 101 (33.6%) in 2019, and 200 (66.4%) in 2021, 130 (43.2%) were female, median age was 66 years (IQR 55.5 – 76). 152 (50.5%) had a history of hypertension. 47 patients (15.6%) had exclusively normal BP values during a median of 10 days (IQR 5 – 21) of hospitalization. Of those 254 patients (84.4%) with elevated BP during the hospitalization, 105 (41.3%) had their antihypertensive treatment adapted: 54/254 patients (21.3%) had > = 1 new antihypertensive, 18/254 patients (7.1%) had the antihypertensive dose increased, 11/254 (4.3%) had the antihypertensive agent exchanged, 47/254 (18.5%) had an antihypertensive stopped, and 22 (8.7%) had the dose decreased (multiple answers possible). Patients with treatment modifications had significantly more complications (22.9 vs 10.3%), p-value 0.012. Differences between patients with and without treatment adaptions are shown in the Table. Conclusions: Elevated BP is a frequent and significant clinical problem during hospitalization. Nearly half of the patients with elevated BP had their medications adapted during hospitalization. Modification of antihypertensive therapy was associated with more complications, whereby no statement can be made about causality.