Scientific Statement AHA: Management of Elevated Blood Pressure in Acute Care Settings https://www.ahajournals.org/doi/10.1161/HYP.0000000000000238 *1. Background and Context* - Elevated blood pressure (BP) affects up to 72% of hospital admissions. - Hypertensive emergencies require immediate treatment with intravenous (IV) antihypertensives. - Asymptomatic elevated BP is common, but treatment risks and benefits are unclear. *2. Definitions* - *Hypertensive Emergency*: BP >180/110–120 mmHg with acute target-organ damage. - *Asymptomatic Markedly Elevated BP*: BP >180/110–120 mmHg without target-organ damage. - *Asymptomatic Elevated BP*: BP ≥130/80 mmHg without target-organ damage. *3. Epidemiology* - Hypertensive emergencies account for 2 in 1,000 adult ED visits. - Asymptomatic elevated BP affects 50–72% of hospitalizations, with higher prevalence in older adults, Black individuals, and those with comorbidities. *4. BP Measurement in Acute Care* - BP measurement is often inconsistent and prone to errors. - Arterial lines are preferred for hypertensive emergencies. *5. Management of Elevated BP* - *Hypertensive Emergency*: Treat with IV antihypertensives to reduce BP by 20–25% within the first hour. - *Asymptomatic Elevated BP*: Treatment is less clear; avoid aggressive treatment, especially with IV medications. *6. Evidence Gaps and Research Priorities* - No randomized trials on treating asymptomatic elevated BP in acute care settings. - Future research should focus on defining optimal BP targets, improving BP measurement practices, and evaluating treatment benefits and risks. *7. Transitions of Care* - Focus on restarting home antihypertensive medications, scheduling timely follow-up, and avoiding unnecessary intensification of antihypertensive regimens. *8. Health Equity Considerations* - Disparities in hypertension management persist, particularly among underinsured, low-income, and minority populations. *9. Key Clinical Implications* - Use proper BP measurement techniques and calibrated devices. - Avoid unnecessary treatment of asymptomatic elevated BP. - Focus on addressing reversible causes of elevated BP. Conclusion The management of asymptomatic elevated BP in acute care settings should be cautious and patient-centered. Overtreatment may lead to harm. Future research is needed to clarify optimal treatment strategies and BP targets. https://youtu.be/kJ-bRaV00XU?si=Yw3cmqTuugh-OJP7