Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department
- Author(s): Miller, Joseph B.
- Arter, Andrew
- Wilson, Suprat S.
- Janke, Alexander T.
- Brody, Aaron
- Reed, Brian P.
- Levy, Phillip D.
- et al.
Published Web Locationhttps://doi.org/10.5811/westjem.2017.5.33410
Introduction: While moderate to severely elevated blood pressure (BP) is present in nearly halfof all emergency department (ED) patients, the incidence of true hypertensive emergencies inED patients is low. Administration of bolus intravenous (IV) antihypertensive treatment to lowerBP in patients without a true hypertensive emergency is a wasteful practice that is discouragedby hypertension experts; however, anecdotal evidence suggests this occurs with relatively highfrequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensivetreatment in ED patients with elevated BP absent a hypertensive emergency.
Methods: We performed a retrospective cohort study from a single, urban, teaching hospital.Using pharmacy records, we identified patients age 18-89 who rec eived IV antihypertensivetreatment in the ED. We defined treatment as inappropriate if documented suspicion for anindicated cardiovascular condition or acute end-organ injury was lacking. Data abstractionincluded adverse events and 30-day readmission rates, and analysis was primarily descriptive.
Results: We included a total of 357 patients over an 18-month period. The mean age was 55;51% were male and 93% black, and 127 (36.4%) were considered inappropriately treated.Overall, labetalol (61%) was the most commonly used medication, followed by enalaprilat(18%), hydralazine (18%), and metoprolol (3%). There were no significant differences betweenappropriate and inappropriate BP treatment groups in terms of clinical characteristics oradverse events. Hypotension or bradycardia occurred in three (2%) patients in the inappropriatetreatment cohort and in two (1%) patients in the appropriately treated cohort. Survival todischarge and 30-day ED revisit rates were equivalent.
Conclusion: More than one in three patients who were given IV bolus antihypertensive treatmentin the ED received such therapy inappropriately by our definitio n, suggesting that significantresources could perhaps be saved through education of providers and development of clearlydefined BP treatment protocols. [West J Emerg Med. 2017;18(5)957-962.]