You’re in the hospital with an acute illness. Perhaps your gallbladder is acting up, doubling you over with abdominal pain. While taking care of you and your gallbladder, the doctors noticed that your blood pressure is elevated. So they adjust your blood pressure medicines to bring it back down to normal. Everything seems hunky-dory.
But if you don’t get close and careful follow-up, those blood pressure pills could do more harm than good.
In a recent post, I showed how common it is for patients to receive antibiotics in the hospital even when those drugs will do more harm than good. Well here's another harmful practice: adding new hypertension medications to patients whose blood pressures jump up during hospital stays. Sometimes it's important to prescribe such medications. But other times, patients are having good blood pressure control at home, and their blood pressures increase in the hospital merely as an artifact of their acute medical condition. For example, acute pain ramps up your sympathetic nervous system, causing your blood pressure to rise. In such a situation, receiving new blood pressure medicine increases the chance that a patient will need to be readmitted to the hospital in the 30 days after discharge, probably because their blood pressures crash once they return home. Here's a picture, from a study out of UCSF showing the increase in readmission rates for people receiving these unnecessary blood pressure medications:
Figure showing the increase in readmission rates for people receiving these unnecessary blood ... [+]
Physicians need to be more cautious about adding new blood pressure medicines to treat hypertension in hospitalized patients. Rising blood pressures in such circumstances might simply be an artifact of acute illness.
And all of us with high blood pressure need to be careful, too. If you get a new blood pressure medicine while you are in the hospital, or an increase in the medicines you’ve already been taking, ask your physician whether you need to keep taking the new medicines after you go home. Make sure, also, to get your blood pressure checked regularly after you leave the hospital, to see if it starts getting too low. If you start feeling lightheaded, call your primary care physician for advice.
Blood pressure medicines are life-saving drugs, preventing heart attacks, strokes, kidney disease, and a whole host of other problems. Just be careful to make sure when you leave the hospital that you aren’t getting too much of a good thing.
