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ELIN KONDRAD, MD, ALLYSON WESTLING, MD, MPH, MEGAN HARPER, MD, AND STEPHANIE WELDON, MLIS

Am Fam Physician. 2025;112(1):81-82

Author disclosure: No relevant financial relationships.

CLINICAL QUESTION

In adults hospitalized for noncardiac diagnoses, does treatment of hypertension with intravenous (IV) antihypertensives improve outcomes?

EVIDENCE-BASED ANSWER

Multiple retrospective, cohort studies have shown that use of IV antihypertensives in adults with hypertensive blood pressure (BP) measurements who have been hospitalized for noncardiac causes is associated with significant harm. Use of IV antihypertensives in these patients increases the risk of acute kidney injury (AKI) by approximately 1.5 times and doubles the risks of myocardial injury and inpatient mortality. (Strength of Recommendation [SOR]: B, cohort studies.) It may also increase the risks of stroke and intensive care unit (ICU) transfer and length of hospital stay. (SOR: B, cohort studies.) Risks of end-organ damage and death increase with a higher number of IV antihypertensive doses. (SOR: B, single cohort study.)

EVIDENCE SUMMARY

A 2023 retrospective, cohort study included 66,140 patients 65 years and older hospitalized for noncardiac diagnoses who had elevated BP in the first 48 hours after hospitalization.1 The study compared patients who were treated with IV antihypertensives or new oral antihypertensives with patients who did not receive these treatments.

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Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email questions@fpin.org.

Copyright © Family Physicians Inquiries Network. Used with permission.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN’s Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

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