- Design
- Cross-sectional survey
- Population
- 166 hospitalists at five US institutions
- Primary outcome
- Beliefs and thresholds for treating asymptomatic raised inpatient blood pressure
- Effect
- 27% thought treatment important, 47% did not; median threshold 170–179 mm Hg
A survey in the Journal of General Internal Medicine (18 September) asked 166 hospitalists at five US hospitals how they handle asymptomatic raised blood pressure — between 140/90 and 210/120 mm Hg — in inpatients.
Only 27% thought treating it important; 47% disagreed. The median systolic at which respondents would intensify treatment was 170–179 mm Hg, and most would lower the threshold for patients with heart failure, stroke or myocardial infarction. Respondents said treatment was often driven by nurse calls, and they preferred not to be called about asymptomatic systolic readings under 170.
This is a survey of opinion, not evidence of benefit or harm. Its value is in naming the gap: there is no high-quality trial guiding this common decision, and practice varies widely. A ward-level agreement on call thresholds and on what to check first — pain, urinary retention, missed home medicines — would reduce reflexive treatment.
- Before treating an asymptomatic high reading, check for pain, retention, anxiety and missed home drugs.
- Agree ward call parameters with nursing staff so readings prompt review, not reflex treatment.
- Avoid intravenous antihypertensives for asymptomatic readings without end-organ damage.
- Adjust oral therapy with discharge follow-up in mind rather than chasing a single number.
Why it matters
Nurse calls, not evidence, are driving much inpatient blood pressure treatment.
Don't overread it
This is a survey of opinion; it cannot show that not treating is safe.
The statistics, in plain English
Response rates varied from 24% to 64% across sites, so the respondents may not represent all hospitalists. These are percentages of stated beliefs, not measured outcomes.
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