IN HOSPITAL DETECTION OF ELEVATED BLOOD PRESSURE (INDEBP) – INTERIM ANALYSIS OF PROSPECTIVE COHORT: IMPACT OF ADAPTION OF ANTIHYPERTENSIVES DURING HOSPITALIZATION ON BLOOD PRESSURE

Objective: Elevated blood pressure (BP) is frequent in hospitalized patients. However it remains unclear if antihypertensive treatment should be adjusted in an acute hospital setting. This study assesses the impact of in-hospital antihypertensive treatment adjustments in patients with elevated in-hospital BP on post-discharge ambulatory BP measurements (ABPM). Design and method: This prospective cohort study enrolled medical inpatients with at least 2 BP readings >=140/90 mmHg. Hospital BP was defined as the mean of these readings. Exclusion criteria included symptomatic hypertension, BP >180/110 mmHg, hospitalization for acute cardiovascular conditions, and missing consent. Standardized BP measurements on the day of inclusion consisted of the mean of the 2nd/3rd measurement after 5 minutes of rest in a seated position. Antihypertensive treatment adaptations during hospitalization were decided by the treating physicians. All patients underwent 24-hour ABPM 4 weeks post-discharge. Hypertension on ABPM was defined as a 24-hour mean BP >=130 or 80 mmHg. Cut-off values for awake and asleep periods were >=135/85 mmHg and >=120/70 mmHg, respectively. Statistical analyses used Wilcoxon signed-rank, Kruskal-Wallis and chi-square tests, as applicable. Results: Of 488 screened patients, 89 were included. Fifty-two patients completed an ABPM. Median age was 71 years; 36.5% were female. Antihypertensive medication was altered in 25 patients (48.1%): 6/25 (24.0%) started a new antihypertensive drug class, 17/25 (68.0%) stopped a drug class, 4/25 (16.0%) had dose increases, and 3/25 (12.0%) had dose decreases (multiple answers possible). Overall, 7/25 (28.0%) patients had increased, 15/25 (60.0%) had decreased, and 3/25 (12.0%) had mixed medication changes. Baseline, hospitalization, and post-discharge data are shown in the table. ABPM results for patients with unchanged and changed antihypertensives are shown in Figure A, with subgroups for increased, decreased and mixed changes in Figure B.Conclusions: Over 50% of patients with elevated in-hospital BP with and without changed antihypertensive treatment during hospitalization were hypertensive post-discharge, regardless of whether antihypertensive treatment was increased or decreased. Therefore, the benefit of in-hospital antihypertensive adjustments remains questionable. Findings emphasize the need for standardized strategies for identifying and managing hypertension during hospitalization, and for post-discharge hypertension evaluation.