Summary
The American Heart Association (AHA) has released a scientific statement recommending personalized treatment approaches and revised terminology for managing elevated blood pressure (BP) in inpatient and emergency settings.1,2 Despite high BP being a key modifiable risk factor for cardiovascular disease, few guidelines exist for its management in acute care settings, including inpatient and emergency.
The definition of "hypertensive emergency" remains unchanged, indicating severe BP elevation (≥ 180/110 mmHg) with end-organ damage. The statement introduces two new categories of asymptomatic hypertension,: "markedly elevated BP" (≥ 180/110 mmHg) and "elevated BP" (> 130/80 mm Hg), and suggests that terms like "hypertensive urgency" and "hypertensive crisis" should be avoided.
The statement also introduces the A-I-M (Assess-Identify-Modify) framework for managing inpatient BP. The framework includes: A = avoid overtreatment by accurately assessing BP and considering factors that could cause inaccuracies (e.g., device type, calibration, and patient position); I = improve BP measurement by identifying and addressing reversible factors (e.g., stress, pain, BP-raising medications, such as IV fluids or NSAIDS, or anxiety); and M = review the patient’s outpatient BP regimen, which is crucial for developing effective long-term management strategies after discharge.
The statement aims to improve BP management in acute settings, reduce unnecessary treatment, and guide patients toward better long-term BP control, noting that treating asymptomatic markedly elevated BP should be the exception instead of the rule.
Sources
1. Bress AP, Anderson TS, Flack JM, et al. The management of elevated blood pressure in the acute care setting: a scientific statement from the American Heart Association. Hypertension. 2024;81(8):e94-e106. doi:10.1161/HYP.0000000000000238.
2. Garba D, Whelton SP, Blumenthal RS. When Should We Treat Elevated Inpatient Blood Pressure? https://www.acc.org/latest-in-cardiology/articles/2024/10/28/10/47/when-should-we-treat-elevated-inpatient-blood-pressure. Published October 2024. Accessed November 25, 2024.
This summary was created with assistance from generative artificial intelligence (ChatGPT, 2025)