Overuse of in-hospital blood pressure medications

Patients in hospital for non-heart related conditions may be unnecessarily receiving blood pressure medication that has no benefit and could instead be harmful in the short term, a new review released today has found.

Led by Flinders University pharmacologist Professor Arduino Mangoni, the article published in Australian Prescriber highlights that while identifying and treating high blood pressure in the community is of vital importance, it’s likely that in-hospital elevations in blood pressure are relatively common and might not reflect poorly controlled blood pressure before admission.

“The measurement of blood pressure in hospital patients significantly differs from the best practice recommended for primary care and outpatients,” says Professor Mangoni, a Strategic Professor of Clinical Pharmacology in Flinders’ College of Medicine and Public Health.

“Measurements may be taken inaccurately, and in many cases factors such as pain, anxiety, noise and interrupted sleep patterns may be contributing to abnormal readings that do not need to be medically treated.”

Professor Arduino Mangoni. Image: Flinders Foundation

The review found recent studies suggest treating acute, asymptomatic, in-hospital elevations in blood pressure may have no benefit. Instead, they may increase the risk of in-hospital and post-discharge complications.

The authors say a significant problem in investigating in-hospital blood pressure elevations and their management is the lack of robust protocols.

“The industry needs to review the criteria used by hospital medical emergency teams in relation to blood pressure elevations,” says Professor Mangoni.

“Pending the development of robust measurement protocols in hospitalised patients, acute blood pressure elevations without additional symptoms or organ damage should not automatically equal treatment.

“Rather, such elevations should facilitate follow-up of blood pressure and other cardiovascular risk factors after discharge, including clear communication with GPs to appropriately plan investigations and management.”

The paper – ‘Blood pressure elevations in hospital’ by Arduino A Mangoni, Elzbieta A Jarmuzewska, Genevieve M Gabb and Patrick Russell – is published in the journal Australian Prescriber. DOI: 10.18773/austprescr.2022.068.

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College of Medicine and Public Health Flinders Health and Medical Research Institute