Adapted from BMJ 7 Dec 2024
In older patients, lowering the blood pressure too aggressively can do more harm than good.
A retrospective study of over 1.33 million Us veterans, 91% men, mean age 71, showed that in those admitted to hospital for at least three days, who had a blood pressure medication added, did not do as well as their doctors expected.
70% of patients will have blood pressure measurements over 140 mm Hg systolic. Sometimes anti-hypertensive medication is added to their existing drug regime, but ischaemia can result, if this is done too rapidly, particularly in older patients.
None of the veterans needed intensive care or surgery. As you all know, admission to hospital is a stressful experience. This can raise the blood pressure on its own. When an extra blood pressure medication was added within 24 hours of admission, the treated group tended to have a rapid drop in blood pressure, acute kidney injury and a 1.69 higher chance of having a stroke, myocardial infarction or death, compared to those who were not given the extra medication.
Researchers say that this aspect of care needs further research to determine when acute blood pressure lowering is really of help.
JAMA Intern Med doi:10.1001/jamainternmed.2024.6213.
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Hmm, this is definitely something that I think we all need to keep in mind if we are admitted to the hospital. Sometimes well meaning doctors recommend treatments that are just too aggressive or extreme for the problem. Like you mentioned in your post, going to the hospital is very stressful and many people will have temporary high blood pressure just from the stress. having blood pressure medication added to their other medications and treatment might be too much for the problem. I remember last year I had to go to the hospital for minor surgery, and my heart rate was way, way up compared to what it usually is. I asked my nurse about it, but she pointed out that I usually have perfectly healthy heart rates, so they weren’t too worried about this short term higher rate. I was stressed, I just needed to focus on calming down and breathing. Once my little day surgery was over, my heart rate came back down to it’s normal speed. Even if we think we are handling stress well, our hearts will always know the truth!
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Yesterday I was in hospital for an operation. During the week my bp had been 124 /122/127 systolic. In hospital it was 169 and 147. As long as it isn’t too low, a few days observation, unless they think you have malignant hypertension, is worth considering.
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This is such an important reminder, thank you for sharing! Overly aggressive blood pressure lowering, especially in older patients or during hospital stays, can definitely do more harm than good. Stress alone can temporarily spike BP, and adding strong meds too quickly can lead to serious complications. It’s a delicate balance, and this post highlights why personalized, cautious care is so vital.
https://sites.google.com/view/bloodpress/home
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