Hypertension may be a common inpatient problem, however, there is little value in the use of statim antihypertensive dosing.
The diagnosis of hypertension…
Requires a persistent elevation in blood pressure somewhere above 140/90. For quaque 4 hora observations repeated hypertension probably warrants some of the doctor’s attention.
Severe hypertension
Hypertension above 180/110 should be managed if there is evidence of end organ involvement. Neurological deficits, or signs and symptoms of renal or cardiovascular involvement with severe hypotension probably constitute an emergency and should be managed as such.
Symptomatic or not, if the patient is >220/120 you should call your boss.
Risk
High-risk patients, such as those with aortic aneurism, cardiovascular pathology, or renal disease might benefit from a lower threshold for treatment.
Selecting an antihypertensive
Innumerable drugs are available, calcium channel blockers and ACE inhibitors are probably the best. Perhaps amlodipine 5-10mg?
Further reading
- Kotwal S. Assessment and management of hypertension in ADULTS in the inpatient ward setting [Internet]. South Eastern Sydney Local Health District; 2024 [cited 2025 Oct 20]. Available from: https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/SESLHDGL%20068%20-%20Assessment%20and%20management%20of%20hypertension%20in%20ADULTS%20in%20the%20inpatient%20ward%20setting.pdf