January 1, 2009

Hypertension in the Hospital

Physician Education

By Mark M. Ryan

While blood pressure control may be a crude, if not poor, gague of overall treatment success or failure, it is one medical concept that most patients can understand. A mild elevation in blood pressure may not be at the top of the problem list during my daily rounds, but I find that patients will bring it to my attention if I fail to mention it during our encounters in the inpatient setting.  On the resources page, you can find a complete review presentation of hypertension in the inpatient setting, or you can click here to go directly to the presentation.

~ August 30, 2009

www.markmryan.com

Very often, patients who have controlled their blood pressure outside of the hospital are dismayed when their nurse or patient care assistant tells them that their blood pressure is high at the beginning of every shift.  While blood pressure control may be a crude, if not poor, gague of overall treatment success or failure, it is one medical concept that most patients can understand. I may be very pleased to tell my patient that their blood urea and creatinine levels are continuing to decrease signaling progress in treating their acute renal failure; however, this information is of little use if my patient believes that treatment is failing after being told that his blood pressure is elevated. A mild elevation in blood pressure may not be at the top of the problem list during my daily rounds, but I find that patients will bring it to my attention if I fail to mention it during our encounter.

Before reflexively ordering an anti-hypertensive medication, the physician should consider common, iatrogenic causes of high blood pressure in hospital patients: anti-hypertensive rebound effect, volume overload, hypoglycemia, and pain or anxiety.

It is also worth reviewing several acute medical conditions that can present as elevated blood pressure and require urgent medical attention: elevated intracranial pressure, alcohol withdrawal, acute renal failure, and hypoxemia or respiratory distress.

On the resources page, you can find a complete review presentation of hypertension in the inpatient setting, or you can click here to go directly to the presentation.

~ August 30, 2009

www.markmryan.com

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