In-Hospital Detection of Elevated Blood Pressure (INDEBP): Study Protocol for a Prospective Study Assessing Persistence of Hypertension and Safety of Deferring Antihypertensive Treatment in Hospitalized Patients (Preprint)

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Abstract
UNSTRUCTURED Background: There is a lack of clear recommendation on how to manage elevated blood pressure (BP) values in hospitalized patients, largely due to the absence of prospective data. Retrospective studies suggest that initiation or intensification of antihypertensive therapy during hospitalization may not improve outcomes and may even be associated with increased risk of adverse events. Methods: This is a single-centre, open-label, prospective study comprising two consecutive phases: an observational phase followed by an intervention phase. All patients hospitalized for non-cardiovascular reasons will be screened for asymptomatic elevated BP values (defined as 140–180 mmHg systolic and/or 90–110 mmHg diastolic on at least two occasions). During the observational phase, patients will be managed according to usual clinical practice. During the intervention phase, a standardized management strategy will be applied, consisting of no initiation or modification of antihypertensive therapy during hospitalization. All participants will undergo 24-hour ambulatory BP monitoring (ABPM) four weeks after hospital discharge. The primary endpoint is the prevalence of persisting new or uncontrolled hypertension on ABPM. Primary safety endpoints include the prevalence of combined hypertensive and hypotensive complications. Discussion: This study aims to provide prospective data on the clinical relevance of elevated BP values in hospitalized patients. By assessing both the persistence of hypertension and the occurrence of adverse events, the study will help to inform future strategies regarding the management of elevated BP in the inpatient setting.

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