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Teachable Moment
Less Is More
May 2018

Overtreatment of Asymptomatic Hypertension—Urgency Is Not an Emergency: A Teachable Moment

Author Affiliations
  • 1Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Intern Med. 2018;178(5):704-705. doi:10.1001/jamainternmed.2018.0126

A 77-year-old woman with hypertension and chronic pancreatitis was admitted to the hospital with epigastric pain. Results of her comprehensive metabolic panel and complete blood cell count were normal. Computed tomography of the abdomen was unremarkable. Intravenous (IV) morphine was administered to alleviate the pain, which was thought to be secondary to chronic pancreatitis. Her pain was well controlled with morphine; however, her blood pressure transiently decreased to 100/64 mm Hg and her 3 home blood pressure medications were held accordingly. The next day, the patient reported recurrence of her epigastric pain and blood pressure was noted to be 247/118 mm Hg. She immediately received a 1-time dose of 20 mg IV hydralazine, causing her blood pressure to decrease to 90/54 mm Hg and remain low for hours. She experienced dizziness, nausea, and vomiting. She received IV normal saline and anti-emetics for nausea. The following day, she had acute kidney injury, to which her prolonged hypotension likely contributed. She was monitored for an additional 2 days until her kidney function improved and was restarted on home antihypertensive medications.