Stopping or continuing chronic antihypertensive therapy during hospitalization.

BACKGROUND

Elevated blood pressure is common among hospitalized patients, but the effects of withholding chronic antihypertensive therapy during hospitalization remain unclear.

OBJECTIVES

To assess the association between continuation versus discontinuation of chronic antihypertensive medications during hospitalization and short- and long-term outcomes.

METHODS

This retrospective propensity score-matched cohort study included adults (≥18 years) with chronic hypertension hospitalized in eight Clalit Health Services hospitals in Israel from January 2014 to May 2024. Eligible patients had received at least one antihypertensive medication continuously for 6 months before admission. Discontinuation was defined as omission of ≥1 chronic medication during hospitalization. Outcomes included in-hospital and 90-day acute kidney injury (AKI), myocardial injury, stroke, and all-cause mortality.

RESULTS

After 1:1 propensity matching, 82,230 patients were analyzed (50,070 internal medicine; 32,160 surgical). In internal medicine departments, discontinuation was associated with higher risk of in-hospital AKI (OR, 1.23; 95% CI, 1.16-1.30), 90-day AKI (OR, 1.19; 95% CI, 1.14-1.24), in-hospital mortality (OR, 2.69; 95% CI, 2.47-2.94), and 90-day mortality (OR, 1.81; 95% CI, 1.72-1.90). In surgical departments, discontinuation was linked to in-hospital myocardial injury (OR, 1.26; 95% CI, 1.10-1.44) but not AKI. Results were consistent across subgroups, including infection-related admissions.

CONCLUSIONS

Discontinuing chronic antihypertensive therapy during hospitalization was associated with increased risks of AKI and mortality. These findings suggest that withholding antihypertensive therapy is unlikely to confer benefit and may be harmful.