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Uber AM, Han J, Grimm P, Montez-Rath ME, Chaudhuri A. Defining systolic blood pressure normative values in hospitalized pediatric patients: a single center experience. Pediatr Res 2024; 95:1860-1867. [PMID: 38326477 DOI: 10.1038/s41390-024-03059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/12/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Normative blood pressure (BP) values and definition of hypertension (HTN) in children in outpatient setting cannot be reliably used for inpatient therapy initiation. No normative exists to describe HTN in hospitalized pediatric populations. We aimed to study the prevalence of hypertension and produce normative BP values in hospitalized children. METHODS Cross sectional observational study of all children hospitalized on acute care floors, ≥2 and <18 years age, at Stanford Children's Hospital, from Jan-01-2014 to Dec-31-2018. Cohort included 7468 hospital encounters with a total of 118,423 automated, oscillometric, BPs measured in the upper extremity during a hospitalization of >24 hours. RESULTS Overall prevalence of HTN, defined by outpatient guidelines, was 12-48% in boys and 6-39% in girls, stage 1 systolic HTN in 12-38% of boys and 6-31% of girls, stage 2 systolic HTN in 3-10% of boys and 1-8% of girls. Centile curves were derived demonstrating overall higher BP reading for hospitalized patients compared to the outpatient setting. CONCLUSION Higher blood pressures are anticipated during hospitalization. Thresholds provided by the centile curves generated in this study may provide the clinician with some guidance on how to manage hospitalized pediatric patients based on clinical circumstances. IMPACT Hospitalized children have higher blood pressures compared to patients in the ambulatory setting, hence outpatient normative blood pressure values cannot be reliably used for inpatient therapy initiation. No normative exists to describe hypertension in hospitalized pediatric populations. The thresholds provided by the centile curves generated in this study may provide the clinician with some guidance on how to manage hospitalized pediatric patients based on clinical circumstances.
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Affiliation(s)
- Amanda M Uber
- Department of Nephrology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Jialin Han
- Department of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul Grimm
- Department of Pediatrics (Nephrology), Stanford University School of Medicine, Stanford, CA, USA
| | - Maria E Montez-Rath
- Department of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
| | - Abanti Chaudhuri
- Department of Pediatrics (Nephrology), Stanford University School of Medicine, Stanford, CA, USA.
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Rachoin JS, Cerceo E, Anderson TS. Things We Do for No Reason™: Intensifying antihypertensive medications for hospitalized patients at the time of discharge. J Hosp Med 2024; 19:219-222. [PMID: 37545427 DOI: 10.1002/jhm.13185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Jean-Sebastien Rachoin
- Department of Medicine, Division of Hospital Medicine, Cooper University Healthcare, Camden, New Jersey, USA
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Elizabeth Cerceo
- Department of Medicine, Division of Hospital Medicine, Cooper University Healthcare, Camden, New Jersey, USA
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Timothy S Anderson
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Tam JM, McHugh KM. Management of Hypertension in the Older Adult Hospitalized With Community-Acquired Pneumonia. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.104525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Yousufuddin M, Murad MH, Peters JL, Ambriz TJ, Blocker KR, Khandelwal K, Pagali SR, Nanda S, Abdalrhim A, Patel U, Dugani S, Arumaithurai K, Takahashi PY, Kashani KB. Within-Person Blood Pressure Variability During Hospitalization and Clinical Outcomes Following First-Ever Acute Ischemic Stroke. Am J Hypertens 2023; 36:23-32. [PMID: 36130108 PMCID: PMC11301580 DOI: 10.1093/ajh/hpac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Uncertainty remains over the relationship between blood pressure (BP) variability (BPV), measured in hospital settings, and clinical outcomes following acute ischemic stroke (AIS). We examined the association between within-person systolic blood pressure (SBP) variability (SBPV) during hospitalization and readmission-free survival, all-cause readmission, or all-cause mortality 1 year after AIS. METHODS In a cohort of 862 consecutive patients (age [mean ± SD] 75 ± 15 years, 55% women) with AIS (2005-2018, follow-up through 2019), we measured SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) from a median of 16 SBP readings obtained throughout hospitalization. RESULTS In the cumulative cohort, the measured SD and CV of SBP in mmHg were 16 ± 6 and 10 ± 5, respectively. The hazard ratios (HR) for readmission-free survival between the highest vs. lowest quartiles were 1.44 (95% confidence interval [CI] 1.04-1.81) for SD and 1.29 (95% CI 0.94-1.78) for CV after adjustment for demographics and comorbidities. Similarly, incident readmission or mortality remained consistent between the highest vs. lowest quartiles of SD and CV (readmission: HR 1.29 [95% CI 0.90-1.78] for SD, HR 1.29 [95% CI 0.94-1.78] for CV; mortality: HR 1.15 [95% CI 0.71-1.87] for SD, HR 0.86 [95% CI 0.55-1.36] for CV). CONCULSIONS In patients with first AIS, SBPV measured as quartiles of SD or CV based on multiple readings throughout hospitalization has no independent prognostic implications for the readmission-free survival, readmission, or mortality. This underscores the importance of overall patient care rather than a specific focus on BP parameters during hospitalization for AIS.
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Affiliation(s)
- Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - M H Murad
- Robert D. and Patricia E. Kern Center for the Science of Healthcare
Delivery, Mayo Clinic, Rochester, Minnesota,
USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine,
Mayo Clinic, Rochester, Minnesota, USA
| | - Jessica L Peters
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - Taylor J Ambriz
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - Katherine R Blocker
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Sanjeev Nanda
- Division of Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Ahmed Abdalrhim
- Division of Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Urvish Patel
- Icahn School of Medicine, Mount Sinai,
New York, USA
| | - Sagar Dugani
- Division of Hospital Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | | | - Paul Y Takahashi
- Division of Community Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic,
Rochester, Minnesota, USA
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Asymptomatic hypertension in the hospital setting: primum non nocere. J Hum Hypertens 2022; 36:781-784. [PMID: 35322179 DOI: 10.1038/s41371-022-00676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/08/2022]
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