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A retrospective look at veterans who received oral and/or IV as needed blood pressure medications while hospitalized in a non-ICU setting found an association with as needed meds and acute kidney injury, greater than 25% blood pressure drop in 3 hours, and death, stroke and MI while hospitalized. IV medications had a higher association.
While needing prospective validation, this appears to be more evidence to treat the patient not the number.
References
Canales MT, Yang S, Westanmo A, Wang X, Hadley D, Ishani A, Mohandas R, Shorr R, Lo-Ciganic W. As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals. JAMA Intern Med. 2025 Jan 1;185(1):52-60. doi: 10.1001/jamainternmed.2024.6213. PMID: 39585709; PMCID: PMC11589853.