Assess Before Rx: Reducing the Overtreatment of Asymptomatic Blood Pressure Elevation in the Inpatient Setting

Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine
Sara D PasikMona Krouss

Abstract

Asymptomatic blood pressure elevation is common in the inpatient setting. National guidelines recommend treating with oral agents to slowly decrease blood pressure; however, many clinicians use intravenous antihypertensive medications, which can lead to unpredictable changes in blood pressure. To decrease the number of inappropriate orders (without symptoms of hypertensive emergency or order for NPO) of intravenous antihypertensives and adverse events associated with intravenous orders. Quasi-experimental study with multidisciplinary intervention. Inpatients with a one-time order for an intravenous antihypertensive agent from January 2016 to February 2018. The main outcomes were the total numbers of orders and inappropriate orders, adverse events, and alternate etiologies per 1,000 patient-days. As a balancing measure, patients were monitored for adverse events when blood pressure was elevated and not treated. There were a total of 260 one-time orders of intravenous antihypertensives on two medical units. Inappropriate orders decreased from 8.3 to 3.3 per 1,000 patient days (P = .0099). Adverse events associated with intravenous antihypertensives decreased from 3.7 to 0.8 per 1,000 patient days (P = .0072). This initiative demo...Continue Reading

Citations

Dec 29, 2020·JAMA Internal Medicine·Radhika RastogiMichael B Rothberg
Apr 18, 2021·American Journal of Hypertension·Kelsi Bean-ThompsonJose Nicolas Codolosa
Jun 3, 2021·Nefrología : publicación oficial de la Sociedad Española Nefrologia·Krishnam R PenmatsaAnkur Gupta

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