Inpatient Management of Hypertension

Classification and Management of Hypertensive States

Hypertensive emergency is defined as BP >180/120 mmHg WITH evidence of acute end-organ damage, requiring immediate treatment in intensive care settings with intravenous antihypertensive medications 1, 3
The American College of Physicians recommends that hypertensive urgency, defined as BP >180/120 mmHg WITHOUT evidence of end-organ damage, be treated with oral medications and follow-up within days to weeks 3, 4
Diagnostic testing for end-organ damage in hypertensive urgency may include physical examination, fundoscopic examination, renal panel, electrocardiogram, and additional imaging if indicated by symptoms 4

Initial assessment of hypertensive emergency should confirm proper BP measurement and evidence of end-organ damage, and evaluate for specific type of emergency 3
The American Heart Association recommends admitting patients with hypertensive emergency to the intensive care unit for close monitoring and using intravenous antihypertensive medications with careful titration 3

No guidelines provide specific inpatient BP targets or recommendations for managing asymptomatic moderately elevated BP in hospitalized patients, and observational studies suggest intensive BP treatment may be associated with adverse outcomes 1, 2, 3
The American College of Cardiology notes that rapid BP reduction >25% within 6 hours may increase the risk of adverse events, and recommends focusing on oral medication adjustment rather than IV medications for non-emergency BP elevation 2

No specific guidelines exist for BP management during transitions from hospital to home, but it is recommended to ensure close outpatient follow-up for patients whose oral regimen was adjusted during hospitalization 4