Key result
Administration of IV PRN antihypertensive medications in hospitalized patients without target organ damage significantly increased hospital length of stay (4.9 vs. 3.1 days, P<0.001).
Why the study?
Many hospitalized patients with acute blood pressure elevations receive intravenous antihypertensives without evidence of benefit.
Does the administration of intravenous as-needed (PRN) antihypertensive medications improve hospital length of stay and mortality in hospitalized patients without target organ damage?
Cohort (n=5,680)
Does the administration of intravenous as-needed (PRN) antihypertensive medications improve hospital length of stay and mortality in hospitalized patients without target organ damage?
Absolute Event Rate: 4.9% vs 3.1%
p-value: p=<0.001
The use of IV PRN antihypertensives in hospitalized patients without target organ damage is associated with increased hospital length of stay and no mortality benefit, highlighting the potential harm of rapid blood pressure lowering in this setting.
Caution against routine IV PRN antihypertensives without target organ damage; leaves open confirmation in randomized trials.
BACKGROUND: Many hospitalized patients with acute elevations in blood pressure (BP) are treated with intravenous (IV) antihypertensive medications without evidence of benefit. This study investigated the effects of IV as-needed (PRN) antihypertensives on BP, hospital length of stay, and mortality. METHODS: We included hospitalized patients with an order for an IV PRN antihypertensive medication. We excluded patients with target organ damage. We performed multivariate analysis to assess whether the medication was independently associated with outcomes. RESULTS: 1,784 out of 5,680 patients (31%) had an administration of the PRN medication. Patients who received the medication had a longer hospital stay compared with patients with an order for the medication who did not receive it (4.9 ± 6.1 vs. 3.1 ± 4.1 days, P < 0.001). This remained statistically significant after adjusting for covariates. In-hospital mortality was higher in the group that received the medication (3.3% vs. 1.6%, P < 0.001), but this was not statistically significant on multivariate analysis. IV hydralazine caused the most significant reduction in BP and led to a shorter length of stay when compared with enalapril and labetalol. A total of 62% of patients received the medication for a systolic BP lower than 180 mm Hg. CONCLUSIONS: Treating hypertension in the in-patient setting remains complex. Rapid lowering of BP can cause harm to patients, and this study showed that antihypertensive medication increased hospital length of stay. Once assuring no target organ damage, a strategic approach should be to treat modifiable factors and gradually reduce BP.
No takes yet. Share an insight, caveat, or question.
Bean-Thompson et al. (2021) conducted a cohort in Acute elevations in blood pressure in hospitalized patients (n=5,680). Intravenous as-needed (PRN) antihypertensive medications vs. Patients with an order for the medication who did not receive it was evaluated on Hospital length of stay (days) (p=<0.001). Administration of IV PRN antihypertensive medications in hospitalized patients without target organ damage significantly increased hospital length of stay (4.9 vs. 3.1 days, P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: