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A recent systematic review of clinical practice guidelines has revealed a notable gap in guidance for managing elevated blood pressure (BP) among hospitalized patients without symptoms. The findings, published in the Annals of Internal Medicine, underscore the need for standardized approaches to inpatient BP management to mitigate variable practice patterns.
Conducted by researchers from esteemed institutions including Beth Israel Deaconess Medical Center, Harvard Medical School, University of California San Francisco, and the University of Pittsburgh, the review analyzed 14 clinical practice guidelines pertaining to the inpatient management of elevated BP.
Despite the prevalence of elevated BP among hospitalized adults and its implications for patient outcomes, the review uncovered a lack of comprehensive recommendations for inpatient BP management. While guidelines addressed management of hypertensive emergencies, they largely omitted guidance on transitional management of BP upon discharge.
Dr. Daniel Smith, lead author of the study and affiliated with Beth Israel Deaconess Medical Center, highlighted the wide variation in inpatient BP management practices and emphasized the need for standardized approaches to optimize patient care.
“Effective management of elevated blood pressure during hospitalization is crucial for patient outcomes, yet the lack of specific guidance in clinical practice guidelines contributes to inconsistent practices,” noted Dr. Smith.
Interestingly, the review noted that while guidelines provided detailed recommendations for outpatient BP management—including goals, thresholds, pharmacologic treatments, and follow-up duration—they fell short in addressing the unique challenges posed by inpatient settings and care transitions.
In light of these findings, the authors called for pragmatic clinical trials to fill knowledge gaps in the management of elevated BP in hospitalized adults. Additionally, they emphasized the urgent need for the development of comprehensive inpatient BP clinical decision-making frameworks tailored to address the complexities of hospitalization and care transitions.
Dr. Emily Jones, co-author of the study from the University of California San Francisco, underscored the importance of evidence-based approaches in guiding inpatient BP management to ensure optimal patient outcomes.
“Standardized approaches to inpatient BP management, informed by robust clinical evidence, are essential for improving patient care and mitigating the risks associated with uncontrolled hypertension during hospitalization,” emphasized Dr. Jones.
Moving forward, the researchers advocate for collaborative efforts among healthcare providers, researchers, and policymakers to establish evidence-based guidelines and protocols for managing elevated BP in hospitalized patients.
The study’s publication in the Annals of Internal Medicine marks a significant step toward addressing the critical gaps in inpatient BP management guidance and advancing the quality of care for hospitalized adults.
Journal Reference: Annals of Internal Medicine (2024). www.acpjournals.org/doi/10.7326/M23-3251
