{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:37:07Z","timestamp":1790419027962,"version":"4.1.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:sec id=\"ab-ioi230029-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Asymptomatic blood pressure (BP) elevations are common in hospitalized older adults, and widespread heterogeneity in the clinical management of elevated inpatient BPs exists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230029-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association of intensive treatment of elevated inpatient BPs with in-hospital clinical outcomes of older adults hospitalized for noncardiac conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230029-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective cohort study examined Veterans Health Administration data between October 1, 2015, and December 31, 2017, for patients aged 65 years or older hospitalized for noncardiovascular diagnoses and who experienced elevated BPs in the first 48 hours of hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230029-7\">\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Intensive BP treatment following the first 48 hours of hospitalization, defined as receipt of intravenous antihypertensives or oral classes not used prior to admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230029-8\">\n                    <jats:title>Main Outcome and Measures<\/jats:title>\n                    <jats:p>The primary outcome was a composite of inpatient mortality, intensive care unit transfer, stroke, acute kidney injury, B-type natriuretic peptide elevation, and troponin elevation. Data were analyzed between October 1, 2021, and January 10, 2023, with propensity score overlap weighting used to adjust for confounding between those who did and did not receive early intensive treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230029-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 66\u202f140 included patients (mean [SD] age, 74.4 [8.1] years; 97.5% male and 2.6% female; 17.4% Black, 1.7% Hispanic, and 75.9% White), 14\u202f084 (21.3%) received intensive BP treatment in the first 48 hours of hospitalization. Patients who received early intensive treatment vs those who did not continued to receive a greater number of additional antihypertensives during the remainder of their hospitalization (mean additional doses, 6.1 [95% CI, 5.8-6.4] vs 1.6 [95% CI, 1.5-1.8], respectively). Intensive treatment was associated with a greater risk of the primary composite outcome (1220 [8.7%] vs 3570 [6.9%]; weighted odds ratio [OR], 1.28; 95% CI, 1.18-1.39), with the highest risk among patients receiving intravenous antihypertensives (weighted OR, 1.90; 95% CI, 1.65-2.19). Intensively treated patients were more likely to experience each component of the composite outcome except for stroke and mortality. Findings were consistent across subgroups stratified by age, frailty, preadmission BP, early hospitalization BP, and cardiovascular disease history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230029-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The study\u2019s findings indicate that among hospitalized older adults with elevated BPs, intensive pharmacologic antihypertensive treatment was associated with a greater risk of adverse events. These findings do not support the treatment of elevated inpatient BPs without evidence of end organ damage, and they highlight the need for randomized clinical trials of inpatient BP treatment targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.1667","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T11:34:13Z","timestamp":1685446453000},"page":"715","source":"Crossref","is-referenced-by-count":65,"title":["Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older Adults"],"prefix":"10.1001","volume":"183","author":[{"given":"Timothy S.","family":"Anderson","sequence":"first","affiliation":[{"name":"Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"San Francisco Veterans Affairs Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoshana J.","family":"Herzig","sequence":"additional","affiliation":[{"name":"Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bocheng","family":"Jing","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Medical Center, San Francisco, California"},{"name":"Division of Geriatrics, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. John","family":"Boscardin","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Medical Center, San Francisco, California"},{"name":"Division of Geriatrics, University of California, San Francisco"},{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Fung","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Medical Center, San Francisco, California"},{"name":"Division of Geriatrics, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Marcantonio","sequence":"additional","affiliation":[{"name":"Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Steinman","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Medical Center, San Francisco, California"},{"name":"Division of Geriatrics, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"7","key":"ioi230029r1","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1002\/jhm.v6.7","article-title":"Prevalence and management of hypertension in the inpatient setting: a systematic review.","volume":"6","author":"Axon","year":"2011","journal-title":"J Hosp Med"},{"key":"ioi230029r2","doi-asserted-by":"publisher","first-page":"k3503","DOI":"10.1136\/bmj.k3503","article-title":"Intensification of older adults\u2019 outpatient blood pressure treatment at hospital discharge: national retrospective cohort study.","volume":"362","author":"Anderson","year":"2018","journal-title":"BMJ"},{"issue":"3","key":"ioi230029r3","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1001\/jamainternmed.2020.7501","article-title":"Treatment and outcomes of inpatient hypertension among adults with noncardiac admissions.","volume":"181","author":"Rastogi","year":"2021","journal-title":"JAMA Intern Med"},{"issue":"11","key":"ioi230029r4","doi-asserted-by":"publisher","first-page":"1528","DOI":"10.1001\/jamainternmed.2019.3007","article-title":"Clinical outcomes after intensifying antihypertensive medication regimens among older adults at hospital discharge.","volume":"179","author":"Anderson","year":"2019","journal-title":"JAMA Intern Med"},{"issue":"6","key":"ioi230029r5","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1161\/HYP.0000000000000066","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"issue":"5","key":"ioi230029r6","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1111\/jgs.v70.5","article-title":"Time to benefit for stroke reduction after blood pressure treatment in older adults: a meta-analysis.","volume":"70","author":"Ho","year":"2022","journal-title":"J Am Geriatr Soc"},{"issue":"12","key":"ioi230029r7","doi-asserted-by":"publisher","first-page":"3900","DOI":"10.1007\/s11606-020-06401-0","article-title":"Older adults\u2019 persistence to antihypertensives prescribed at hospital discharge: a retrospective cohort study.","volume":"36","author":"Anderson","year":"2021","journal-title":"J Gen Intern Med"},{"issue":"3","key":"ioi230029r8","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1111\/jch.v24.3","article-title":"Severe inpatient hypertension prevalence and blood pressure response to antihypertensive treatment.","volume":"24","author":"Ghazi","year":"2022","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"19","key":"ioi230029r9","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1056\/NEJMcp1901117","article-title":"Acute severe hypertension.","volume":"381","author":"Peixoto","year":"2019","journal-title":"N Engl J Med"},{"issue":"4","key":"ioi230029r10","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/0003-4819-154-4-201102150-00008","article-title":"Intensive insulin therapy in hospitalized patients: a systematic review.","volume":"154","author":"Kansagara","year":"2011","journal-title":"Ann Intern Med"},{"issue":"2","key":"ioi230029r11","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1161\/HYPERTENSIONAHA.121.17279","article-title":"Pro re nata antihypertensive medications and adverse outcomes in hospitalized patients: a propensity-matched cohort study.","volume":"78","author":"Mohandas","year":"2021","journal-title":"Hypertension"},{"issue":"8","key":"ioi230029r12","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using big data to emulate a target trial when a randomized trial is not available.","volume":"183","author":"Hern\u00e1n","year":"2016","journal-title":"Am J Epidemiol"},{"key":"ioi230029r13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-071108","article-title":"Target trial emulation: applying principles of randomised trials to observational studies.","volume":"378","author":"Matthews","year":"2022","journal-title":"BMJ"},{"issue":"4","key":"ioi230029r14","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1002\/pds.v28.4","article-title":"A systematic review of methods for determining cross-sectional active medications using pharmacy databases.","volume":"28","author":"Anderson","year":"2019","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"10","key":"ioi230029r15","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1097\/MLR.0000000000001188","article-title":"Comparison of pharmacy database methods for determining prevalent chronic medication use.","volume":"57","author":"Anderson","year":"2019","journal-title":"Med Care"},{"issue":"2","key":"ioi230029r16","doi-asserted-by":"publisher","first-page":"R31","DOI":"10.1186\/cc5713","article-title":"Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury.","volume":"11","author":"Mehta","year":"2007","journal-title":"Crit Care"},{"issue":"4","key":"ioi230029r17","doi-asserted-by":"publisher","first-page":"c179","DOI":"10.1159\/000339789","article-title":"KDIGO clinical practice guidelines for acute kidney injury.","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron Clin Pract"},{"issue":"3","key":"ioi230029r18","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1093\/eurheartj\/ehi631","article-title":"NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study.","volume":"27","author":"Januzzi","year":"2006","journal-title":"Eur Heart J"},{"issue":"2","key":"ioi230029r19","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1097\/MLR.0b013e318158aed6","article-title":"Impact of the present-on-admission indicator on hospital quality measurement: experience with the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators.","volume":"46","author":"Glance","year":"2008","journal-title":"Med Care"},{"issue":"24","key":"ioi230029r20","doi-asserted-by":"publisher","first-page":"2673","DOI":"10.1001\/jama.2016.7050","article-title":"Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged =75 years: a randomized clinical trial.","volume":"315","author":"Williamson","year":"2016","journal-title":"JAMA"},{"issue":"19","key":"ioi230029r21","doi-asserted-by":"publisher","first-page":"2176","DOI":"10.1016\/j.jacc.2017.11.004","article-title":"Systematic review for the 2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"71","author":"Reboussin","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"ioi230029r22","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1093\/aje\/kwp425","article-title":"Multiple imputation for missing data: fully conditional specification versus multivariate normal imputation.","volume":"171","author":"Lee","year":"2010","journal-title":"Am J Epidemiol"},{"issue":"23","key":"ioi230029r23","doi-asserted-by":"publisher","first-page":"2417","DOI":"10.1001\/jama.2020.7819","article-title":"Overlap weighting: a propensity score method that mimics attributes of a randomized clinical trial.","volume":"323","author":"Thomas","year":"2020","journal-title":"JAMA"},{"issue":"27","key":"ioi230029r24","doi-asserted-by":"publisher","first-page":"6150","DOI":"10.1002\/sim.v40.27","article-title":"Informing power and sample size calculations when using inverse probability of treatment weighting using the propensity score.","volume":"40","author":"Austin","year":"2021","journal-title":"Stat Med"},{"issue":"8","key":"ioi230029r25","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1093\/gerona\/gly197","article-title":"Validation of a claims-based frailty index against physical performance and adverse health outcomes in the Health and Retirement Study.","volume":"74","author":"Kim","year":"2019","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"7","key":"ioi230029r26","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1093\/gerona\/glab071","article-title":"Updating and validating the U.S. Veterans Affairs Frailty Index: transitioning from ICD-9 to ICD-10.","volume":"76","author":"Cheng","year":"2021","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"4","key":"ioi230029r28","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value.","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"issue":"10","key":"ioi230029r29","doi-asserted-by":"publisher","first-page":"2330","DOI":"10.1097\/CCM.0b013e3182227238","article-title":"Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension registry.","volume":"39","author":"Mayer","year":"2011","journal-title":"Crit Care Med"},{"issue":"4","key":"ioi230029r30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0265497","article-title":"Blood pressure response to commonly administered antihypertensives for severe inpatient hypertension.","volume":"17","author":"Ghazi","year":"2022","journal-title":"PLoS One"},{"issue":"3","key":"ioi230029r31","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1002\/jhm.v11.3","article-title":"As-needed intravenous antihypertensive therapy and blood pressure control.","volume":"11","author":"Lipari","year":"2016","journal-title":"J Hosp Med"},{"issue":"2","key":"ioi230029r32","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1097\/HJH.0000000000003328","article-title":"Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage.","volume":"41","author":"Ghazi","year":"2023","journal-title":"J Hypertens"},{"issue":"8","key":"ioi230029r33","doi-asserted-by":"publisher","first-page":"HO2","DOI":"10.7326\/M20-1021","article-title":"Web exclusive. Annals for Hospitalists inpatient notes\u2014inpatient hypertension-to treat or tolerate?","volume":"172","author":"Anderson","year":"2020","journal-title":"Ann Intern Med"},{"issue":"6","key":"ioi230029r34","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1001\/jamainternmed.2022.1657","article-title":"Time to clinical benefit of intensive blood pressure lowering in patients 60 years and older with hypertension: a secondary analysis of randomized clinical trials.","volume":"182","author":"Chen","year":"2022","journal-title":"JAMA Intern Med"},{"key":"ioi230029r27","unstructured":"Chronic Conditions Warehouse. Centers for Medicare & Medicaid Services; 2021. Accessed October 9, 2021. https:\/\/www2.ccwdata.org\/web\/guest\/condition-categories-chronic"}],"container-title":["JAMA Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/articlepdf\/2805021\/jamainternal_anderson_2023_oi_230029_1687982028.79016.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T11:19:41Z","timestamp":1688383181000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2805021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,1]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamainternmed.2023.1667","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.742664794.793598953","asserted-by":"object"}]},"ISSN":["2168-6106"],"issn-type":[{"value":"2168-6106","type":"print"}],"subject":[],"published":{"date-parts":[[2023,7,1]]}}}