Half of hospitalists think asymptomatic inpatient hypertension should be left alone — and say the nurse's call is what drives treatment

Design

Cross-sectional survey, investigator-written questionnaire

Population

166 hospitalists across 5 US institutions, 2024

Primary outcome

Stated preference for intensifying antihypertensives for asymptomatic elevated inpatient blood pressure

Effect

27% agreed treatment is important, 47% disagreed; median intensification threshold systolic 170–179 mmHg

There is no high-quality evidence for treating an asymptomatic raised blood pressure reading in a hospitalised patient, and the practice varies accordingly. This survey of 166 hospitalists across five institutions asked what they actually do, defining elevated as 140/90 mmHg or above and below 210/120 mmHg.

Twenty-seven per cent agreed it was important to treat; 47% disagreed. The median threshold for intensifying antihypertensives was a systolic of 170 to 179 mmHg — well above the definition of hypertension and above most ward protocols' call thresholds. Comorbidity shifted the answer: respondents were more likely to treat with a history of heart failure or stroke (73% each), myocardial infarction (64%) or coronary disease (57%).

The most useful finding is the most candid one. Respondents agreed strongly that they would prefer not to be contacted about an asymptomatic systolic below 170 mmHg, and agreed that treatment is driven by nurses calling physicians. That describes a system where the decision to give an extra antihypertensive is set by a monitoring threshold written into an observation chart, not by a clinician weighing the patient.

• Set the ward call threshold deliberately — it is functionally the treatment threshold
• Document on admission what blood pressure you want to be told about, and what you want done
• Acute intensification in an asymptomatic inpatient risks hypotension on mobilisation and confuses the discharge medication list
• A raised inpatient reading is an indication to arrange outpatient follow-up, not usually to change the regimen
• Where the patient has heart failure or recent stroke, the calculus genuinely differs — say so explicitly rather than leaving it to the covering doctor

Why it matters

It names the real mechanism behind a very common inpatient prescription, and it is not clinical judgement.

Don't overread it

This is a survey of stated preference at five US hospitals with response rates from 24% to 64%. It describes what physicians say they do, not what happens on the ward or what outcomes follow.

The statistics, in plain English

With response rates as low as 24% at some sites, non-response bias is a real concern: physicians with strong views on inpatient hypertension are more likely to complete a survey about it. The 27% versus 47% split is therefore better read as evidence that no consensus exists than as an estimate of how many hospitalists hold each view.

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