Abstract P028: Intravenous Anti-hypertensives Used for Non-urgent Hypertension in Inpatients
Background: Asymptomatic hypertension is common in hospitalized patients but there are no clear treatment guidelines. Due to the concern for harm from elevated blood pressures (BP) physicians often prescribe rapidly acting intravenous (IV) agents, which may cause dangerous BP drops. We evaluated if the use of IV hydralazine or labetalol were associated with adverse events.
Methods: We retrospectively identified patients >18 years of age admitted to Boston Medical Center over 1 year who had a recorded systolic BP > 160 mmHg or diastolic BP > 120mmHg during their hospitalization. Patients with hypertensive emergency, or admitted to intensive care or neurology services were excluded. We examined adverse events over the subsequent 24 hours comparing the use of IV labetalol and/or hydralazine versus use of neither IV anti-hypertensive in Cox proportional hazard models adjusted for age, gender, race, systolic and diastolic BP.
Results: 5,431 patients met inclusion criteria of which 203 patients received IV anti-hypertensives (78 labetalol only, 107 hydralazine only, 18 hydralazine and labetalol). In adjusted analyses, patients who received IV anti-hypertensives had increased risk of requiring IV fluids (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.03-2.01; P<0.03), and developing tachycardia (HR 1.82; 95% CI 1.18-2.82; P<0.007) compared to patients who did not receive IV agents. There was no difference in orders for computed tomography head, neurology or critical care consult, electrocardiogram, and troponin. The use of IV hydralazine compared with no IV drugs was associated with increased IV fluid use (HR 2.03; 95% CI 1.35-3.05; P<0.001) and tachycardia (HR 1.81; 95% CI 1.04-3.16; P<0.04), with no association of adverse events with IV labetalol use. There was no significant difference in 20% or 50% systolic blood pressure drop at 2 or 6 hours between IV hydralazine, IV labetalol or no IV anti-hypertensive groups.
Conclusions: In contrast to previous concerns, our data suggest that the use of IV hydralazine or labetalol was not associated with severe adverse outcomes. Our retrospective study at a single center has several limitations and did not include all possible confounders, and future studies need to replicate these findings in other centers.
Author Disclosures: F. Rahman: None. J. Weinberg: None. S. Bernard: None. L. Arnold: None.
- © 2015 by American Heart Association, Inc.