Key result
Earlier administration of oral antihypertensives in hospitalized patients with hypertensive urgency was associated with a greater sustained reduction in systolic blood pressure (median 22.9% reduction at 12-24 hours).
Why the study?
Guidelines recommend oral antihypertensives in hypertensive urgency but provide limited implementation guidance, leaving it unclear whether time to initiation impacts blood pressure reduction.
Does earlier initiation of oral antihypertensives improve blood pressure reduction in hospitalized patients with hypertensive urgency?
Observational (n=220)
Does earlier initiation of oral antihypertensives improve blood pressure reduction in hospitalized patients with hypertensive urgency?
Earlier administration of oral antihypertensives in hospitalized patients with hypertensive urgency is associated with a larger and more rapid sustained reduction in systolic blood pressure.
Earlier initiation was associated with greater sustained SBP reduction in hypertensive urgency; hypothesis-generating and requires randomized confirmation.
PURPOSE: In hypertensive urgency, guidelines recommend oral antihypertensives, but with limited guidance on implementation. The objective of this study was to determine whether time to initiation of oral antihypertensives impacts blood pressure (BP) reduction in patients with hypertensive urgency. METHODS: A descriptive study was conducted of adult hospitalized patients with hypertensive urgency from November 2018 through November 2021. Patients with a systolic BP (SBP) of 180 mm Hg or higher or a diastolic BP (DBP) of 120 mm Hg or higher and receipt of oral antihypertensives within 48 hours of presentation were included. The primary outcome was the percentage change in SBP from baseline at 12 to 24 hours and 24 to 48 hours. Secondary outcomes included the change in DBP and mean arterial pressure (MAP), time to 3 consecutive goal SBP readings, continuation of home oral antihypertensives, administration of intravenous (IV) antihypertensives, and length of stay (LOS). Patients were stratified by quartile (Q1 through Q4) based on time to first oral antihypertensive. RESULTS: A total of 220 patients were included. A significant difference in SBP was observed among the quartiles, due to the greater sustained SBP reduction in Q1 at 12 to 24 hours and 24 to 48 hours (median [interquartile range, IQR], 22.9% [13.1%-30.5%] and 22.5% [IQR, 15.8%-32.9%] reduction, respectively). There were also reductions in DBP and MAP, with Q1 consistently having larger reductions than Q4. Patients in Q1 had 3 consecutive goal SBP readings earlier than those in the other quartiles (median [IQR], 13.1 [7.0-21.5] hours). Continuation of home medications, number of IV antihypertensives, and LOS did not differ among the quartiles. CONCLUSION: In this analysis, earlier administration of oral antihypertensives was associated with a larger sustained reduction in SBP.
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Chun et al. (2022) conducted an observational in Hypertensive urgency (n=220). Earlier administration of oral antihypertensives (Quartile 1) vs. Later administration of oral antihypertensives (Quartiles 2-4) was evaluated on Percentage change in SBP from baseline at 12 to 24 hours and 24 to 48 hours. Earlier administration of oral antihypertensives in hospitalized patients with hypertensive urgency was associated with a greater sustained reduction in systolic blood pressure (median 22.9% reduction at 12-24 hours).
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