Tackling inappropriate prescription of blood pressure medication in hospitalized adults: A pre-post intervention study

Background
In 2023, Smarter Medicine included the recommendation “No systematic pharmacological treatment of elevated blood pressure (BP) during an acute hospitalization” in its top-5 list for general internal medicine. High BP is common in hospitalized patients due to a range of patient- and hospital-related factors such as pain, fever, anxiety, sleep deprivation, substance withdrawal, and medication changes. While aggressive BP treatment is necessary in hypertensive emergencies, intensifying BP medications in other inpatient situations has been linked to increased risks of adverse events like falls, syncope, and readmission—without improving long-term BP control or reducing cardiovascular events. Despite this, inappropriate intensification of BP medication remains common.

Aims
We aim to:

1. Identify knowledge gaps among general internal medicine residents and nurses regarding appropriate initiation and intensification of BP medication in hospitalized patients.

2. Develop an intervention to reduce inappropriate use of BP medication in inpatients.

3. Evaluate the impact of the intervention on prescribing practices through a pre-post intervention study.

Methods
Aim 1: We will conduct an online survey among residents and nurses at the Department of General Internal Medicine, Bern University Hospital, to assess knowledge gaps in the management of elevated BP in inpatients.

Aim 2: Using insights from the survey, the Smarter Medicine recommendation, and other existing guidelines, we will design a targeted intervention. This will include a teaching session, an e-learning module, and a concise one-page pocket guideline. All materials will be tailored for both residents and nurses.

Aim 3: The intervention will be implemented across General Internal Medicine wards at Bern University Hospital over a six-month period. To evaluate its effectiveness, we will conduct chart reviews of electronic medical records before and after the intervention to assess changes in the appropriateness of BP medication initiation or intensification.

Expected Impact 
This study will highlight existing knowledge gaps in the inpatient management of elevated BP and lead to a targeted intervention designed to reduce low-value practices. We expect a meaningful reduction in the inappropriate intensification or initiation of BP medication in patients without end-organ damage.

Benefit for Patients and the Public
By addressing the inappropriate use of BP medications in hospitalized patients, this project aims to lower the risk of adverse outcomes such as falls, syncope, and hospital readmissions—ultimately improving patient safety and care quality.