TY - JOUR
T1 - Hypertensive urgency or emergency? The use of intravenous medications in hospitalized hypertensive patients without organ dysfunction
AU - Allgaier, Joshua
AU - Emmich, Megan
AU - Rastegar, Vida
AU - Stefan, Mihaela S.
AU - Lagu, Tara
N1 - Funding Information:
Baystate Health, Dr. Lagu is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number 1R01HL146884-01 and R01 HL139985-01A1. Dr. Lagu has served as a consultant for the Yale Center for Outcomes Research and Evaluation, under contract to the Centers for Medicare and Medicaid Services, for which she has provided clinical and methodological expertise and input on the development, reevaluation, and implementation of hospital outcome and efficiency measures. The views expressed in this manuscript do necessarily reflect those of the Yale Center for Outcomes Research and Evaluation or the Centers for Medicare and Medicaid Services.
Funding Information:
Dr. Lagu is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number 1R01HL146884 - 01 and R01 HL139985 - 01A1 . Dr. Lagu has served as a consultant for the Yale Center for Outcomes Research and Evaluation, under contract to the Centers for Medicare and Medicaid Services, for which she has provided clinical and methodological expertise and input on the development, reevaluation, and implementation of hospital outcome and efficiency measures. The views expressed in this manuscript do necessarily reflect those of the Yale Center for Outcomes Research and Evaluation or the Centers for Medicare and Medicaid Services.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background: Current guidelines poorly define hypertensive urgency and recommend Oral (PO) medications over intravenous (IV). Objective: To describe hospital management of hypertensive urgency and compare characteristics and outcomes of PO vs. IV medications. Methods: We used descriptive statistics and created generalized linear models to evaluate within-subject blood pressure (BP) changes over 24 hours. Results: 179 patients had an average age of 62 and 58% female. Chronic hypertension was common (165, 88%), as was chronic renal disease (40.6%). IV medications were common (146, 81.6%) and associated with higher comorbidity burden, prior kidney disease, and longer length of stay (2.5, 1.6-3.8 vs. 1.4, 0.9-2.2, p=0.007). 66 (35.3%) developed and 43 (23.5%) new organ dysfunction, but outcomes were similar between groups. BP was similar between groups after 12 hours. Conclusions: IV medication use was common and decreased BP more rapidly. Outcomes including BP were similar to PO administration, except for length of stay.
AB - Background: Current guidelines poorly define hypertensive urgency and recommend Oral (PO) medications over intravenous (IV). Objective: To describe hospital management of hypertensive urgency and compare characteristics and outcomes of PO vs. IV medications. Methods: We used descriptive statistics and created generalized linear models to evaluate within-subject blood pressure (BP) changes over 24 hours. Results: 179 patients had an average age of 62 and 58% female. Chronic hypertension was common (165, 88%), as was chronic renal disease (40.6%). IV medications were common (146, 81.6%) and associated with higher comorbidity burden, prior kidney disease, and longer length of stay (2.5, 1.6-3.8 vs. 1.4, 0.9-2.2, p=0.007). 66 (35.3%) developed and 43 (23.5%) new organ dysfunction, but outcomes were similar between groups. BP was similar between groups after 12 hours. Conclusions: IV medication use was common and decreased BP more rapidly. Outcomes including BP were similar to PO administration, except for length of stay.
KW - Hypertension
KW - Hypertensive crisis
KW - Hypertensive urgency
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U2 - 10.1016/j.hrtlng.2020.09.014
DO - 10.1016/j.hrtlng.2020.09.014
M3 - Article
C2 - 33011460
AN - SCOPUS:85091971307
SN - 0147-9563
VL - 49
SP - 824
EP - 828
JO - Heart and Lung: Journal of Acute and Critical Care
JF - Heart and Lung: Journal of Acute and Critical Care
IS - 6
ER -