In an inpatient setting, elevated blood pressure (BP; > 140/90 mm Hg) is very common; a 2011 systematic review of nine cohort and cross-sectional studies found a prevalence of 51% to 72%. A recent systematic review found that among 14 international clinical practice guidelines on hypertension, none addressed inpatient BP goals or management of moderately elevated BPs (140–179/90–119 mm Hg) in the hospital. Although the long-term benefits of outpatient BP control are well established, it is not clear whether initiating or intensifying antihypertensive therapy in the hospital is necessary or beneficial. In fact, two large cohort studies have suggested that such therapy may cause more harm than good. The first study evaluated adults hospitalized in 2017 for noncardiac diagnoses at 10 hospitals in the Cleveland Clinic health system; 78% had at least one elevated BP reading prior to discharge. About 1 in 3 of these patients received acute hypertension treatment, defined as “administ...
