Evidence-Based Inpatient Management of Asymptomatic Elevated Blood Pressure: A Quality Improvement Initiative

Introduction Asymptomatic elevated blood pressure (AEBP) is common among hospitalized patients and often reflects transient, context-related factors. Reflex pharmacologic treatment may expose patients to avoidable harms, including hypotension and acute kidney injury (AKI). Contemporary guidelines recommend confirmation of elevated readings, correction of reversible contributors, and avoidance of routine antihypertensive therapy in the absence of target-organ injury. Methods We conducted a single-center, retrospective pre-post quality improvement (QI) study on general medicine wards (pre-education: October–November 2024; post-education: May–June 2025). Adults with systolic blood pressure (SBP) of 130–180 mmHg or diastolic blood pressure (DBP) of 80–110 mmHg without symptoms or acute target-organ injury were included. A pragmatic multidisciplinary education bundle aligned with the 2024 ACC/AHA scientific statement was implemented. The primary outcome was any antihypertensive medication administered for AEBP; secondary outcomes included route of administration, safety events, discharge intensification, and length of stay. Results Among 394 patients (pre n=214; post n=168), antihypertensive treatment decreased from 16.4% to 7.1% (p=0.007). Among treated patients, oral-only therapy increased, while combined intravenous and oral therapy was eliminated (p=0.041). Safety outcomes remained stable, with no increase in hypotension, abrupt SBP reduction, or AKI. The last DBP on the day of discharge was higher post-education, consistent with less aggressive inpatient treatment. Discharge intensification declined, and the length of stay trended lower. Conclusion A guideline-based educational intervention reduced low-value pharmacologic treatment of asymptomatic inpatient BP without evidence of harm, supporting conservative, evidence-based inpatient BP management.