Reducing Unnecessary Treatment of Asymptomatic Elevated Blood Pressure with Intravenous Medications on the General Internal Medicine Wards: A Quality Improvement Initiative

Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine
Zachary G JacobsSajan Patel

Abstract

Asymptomatic elevated blood pressure (BP) is common in the hospital. There is no evidence supporting the use of intravenous (IV) antihypertensives in this setting. To determine the prevalence and effects of treating asymptomatic elevated BP with IV antihypertensives and to investigate the efficacy of a quality improvement (QI) initiative aimed at reducing utilization of these medications. Retrospective cohort study. Urban academic hospital. Patients admitted to the general medicine service, including the intensive care unit (ICU), with ≥1 episode of asymptomatic elevated BP (>160/90 mm Hg) during hospitalization. A two-tiered, QI initiative. The primary outcome was the monthly proportion of patients with asymptomatic elevated BP treated with IV labetalol or hydralazine. We also analyzed median BP and rates of balancing outcomes (ICU transfers, rapid responses, cardiopulmonary arrests). We identified 2,306 patients with ≥1 episode of asymptomatic elevated BP during the 10-month preintervention period, of which 251 (11%) received IV antihypertensives. In the four-month postintervention period, 70 of 934 (7%) were treated. The odds of being treated were 38% lower in the postintervention period after adjustment for baseline charact...Continue Reading

Citations

Aug 16, 2019·Journal of Hypertension·Massimo SalvettiMaria Lorenza Muiesan
Mar 23, 2020·High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension·Massimo SalvettiMaria Lorenza Muiesan
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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