In a retrospective cohort study of 712 hospitalized adults with musculoskeletal trauma (no known hypertension) who had two inpatient BP readings >140/90 mm Hg, receiving antihypertensives was linked to markedly higher odds of hypotension requiring intervention (OR 11.9, 95% CI 5.69–26.4) without clear benefit in mortality or length of stay.

Why It Matters To Your Practice

• Reactive (stress-related) hypertension after trauma is common, but this study suggests routine inpatient antihypertensive prescribing in patients without known HTN may carry substantial downside.

• The signal was strong despite a relatively young cohort (mean age 35; 77% male) with few comorbidities (obesity 6.2%; diabetes 4.6%).

Clinical Benefits

• No statistically significant association with in-hospital death (OR 5.18, 95% CI 0.79–39.6).

• No clear reduction in length of stay (difference 1.5 days, 95% CI -0.1 to 3.1) or faster discharge alive (HR 0.79, 95% CI 0.59–1.06).

Managing Risks

• Hypotension risk was much higher with antihypertensive exposure (OR 11.9), and hypotension in trauma can worsen perfusion, pain control tolerance, and peri-op stability.

• Before treating elevated inpatient BP in trauma patients without known HTN, reassess for reversible drivers (pain, anxiety, hypovolemia, withdrawal, missed meds, bladder distention) and confirm technique/repeat measurements.

The Bottom Line

• For hospitalized musculoskeletal trauma patients with two BP readings >140/90 and no prior hypertension, antihypertensive treatment was associated with substantially more hypotension and no demonstrated improvement in mortality or LOS in this cohort.