Hydralazine use for the management of hypertensive crises in a medical intensive care unit

Background: Hypertensive crises, including emergent or urgent hypertension, are rare but life-threatening complications of uncontrolled hypertension. Hydralazine is one of several antihypertensive medications available for treatment of hypertensive crises. Major United States guidelines on hypertension recommend conservative use of hydralazine – only for situations of preeclampsia or eclampsia with pregnancy – due to significant adverse effects and unpredictability in the dose response. Methods: A retrospective chart review was conducted on patients admitted to the medical intensive care unit at University Medical Center in Lubbock, Texas, with urgent or emergent hypertension between January 1, 2017, and June 30, 2017. Demographic information - age and gender - and records of which antihypertensive medication(s) and route used were collected. Systolic blood pressure before and 2 hours after hydralazine administration - and whether it was given after an initial dose of another antihypertensive medication - was recorded. Patient comorbidities and contraindications for use were noted. Results: Thirty-five patients were included in this study (1 patient result was excluded from certain calculations due to missing data). Mean age of patients was 53.4 ± 12.5 years. Range was 22-74 years. Eight patients had initial treatment with hydralazine, and 29 out of 35 patients were given hydralazine when considering combination treatment. IV hydralazine was preferred over PO hydralazine (23 patients vs. 6 patients). Sixteen patients had comorbidities and/or contraindications for hydralazine use, but 12 patients received IV hydralazine and one patient received PO hydralazine. Conclusion: Hydralazine was not used in a guideline-directed manner in the medical intensive care unit at our hospital. Physicians should regularly evaluate patients for the presence or absence of end-organ damage concurrent with a blood pressure >180/120 mmHg before considering which antihypertensive medication to use. Hydralazine should be reserved for special situations involving pregnancy.