Management of severe asymptomatic hypertension in the hospitalized patient

Vondracek, Sheryl F.; Scoular, Sarah; Patel, Toral

doi:10.1016/j.jash.2016.10.008

Cited by 8 publications

(13 citation statements)

References 42 publications

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“…Indeed, even if physicians often chose a calcium channel inhibitor, a myriad of different medications was prescribed. Over‐prescription of antihypertensive drugs in the context of acute asymptomatic hypertension is potentially associated with iatrogenic events, such as episodes of cerebral hypo‐perfusion with confusion or falls, especially in the elderly . In some situations, arterial hypertension may constitute a physiological hemodynamic compensation mechanism that maintains effective perfusion of the organs, especially in a surgical context .…”

Section: Resultsmentioning

confidence: 99%

“…Overprescription of antihypertensive drugs in the context of acute asymptomatic hypertension is potentially associated with iatrogenic events, such as episodes of cerebral hypo-perfusion with confusion or falls, especially in the elderly. 9,25 In some situations, arterial hypertension may constitute a physiological hemodynamic compensation mechanism that maintains effective perfusion of the organs, especially in a surgical context. 26 Such auto-regulatory mechanisms should not be blocked with inappropriate initiation of antihypertensive drugs.…”

Section: Discussionmentioning

confidence: 99%

“…However, physicians commonly prescribe antihypertensive drugs ‘as required’ in cases of acute hypertension during hospitalization despite the absence of a rational e in terms of efficacy and safety . For such conditional prescriptions, administration is generally triggered by a SBP and/or a DBP measurement beyond a given threshold, specified in the medical prescription.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…8 However, physicians commonly prescribe antihypertensive drugs 'as required' in cases of acute hypertension during hospitalization despite the absence of a rationale in terms of efficacy and safety. 9 For such conditional prescriptions, administration is generally triggered by a SBP and/or a DBP measurement beyond a given threshold, specified in the medical prescription. Pak KJ et al showed that, in the absence of guidelines, the target pressures that trigger administration vary highly between prescribers, raising questions concerning the clinical interest of such prescriptions.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

“…We found that 78.8% [CI 95%: 77.8-79.8] of OCA prescriptions were prescribed until the day of patient discharge. The median duration of OCA prescription was 4 days (IQR: 2-7), for a median length of stay of 7 days (IQR: [3][4][5][6][7][8][9][10][11][12][13][14]. The repartition of the drugs prescribed according to their ATC class is presented in 11.2-12.6]) prescriptions for urapidil (exhaustive list of drugs prescribed in Appendix S1).…”

Section: Characterization Of the Conditional Prescriptionsmentioning

confidence: 99%

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Conditional prescriptions of oral antihypertensive drugs for the management of hypertension urgencies in the inpatient setting: An observational study

et al. 2019

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What is known and objectives The management of hypertension urgencies during hospitalization may generally not necessitate urgent care. However, physicians frequently prescribe ‘as needed’ antihypertensive drugs for which administration is triggered by blood pressure thresholds. The lack of rationale for this hospital practice led us to study oral conditional antihypertensive (OCA) prescriptions. We aimed to estimate the prevalence of OCA prescriptions and to establish their characteristics. Methods In our institution, prescriptions are computerized. The study was retrospectively performed using a hospital clinical data warehouse over a 5‐year period. Results and discussion The prevalence of OCA prescriptions was 6.9% among subjects treated with an antihypertensive drug. The median duration of these prescriptions was 4 days, until the day of the patient discharge in 78.8% stays. The calcium channel inhibitors were the main (79.9%) pharmacological class prescribed, with mostly prescriptions of nicardipine. OCA prescriptions were associated with another antihypertensive medication in 58.8% of the prescriptions; for 19.3%, it was a medication belonging to the same pharmacological class than the OCA drug prescribed. Regarding the computerized drafting, 39.6% of the conditional prescriptions were considered uninterpretable. At least one administration by nurses concerned 65.1% of the OCA prescriptions. The mean SBP and DBP before the initiation of an OCA drug was 142.9 ± 28.2 and 75.8 ± 24.5 mm Hg, respectively, relative to 143.0 ± 24.9 and 77.6 ± 19.9 mm Hg after the initiation (P = .8 for SBP and P = .06 for DBP). What is new and conclusion The originality of this study lies in the use of a clinical data warehouse to evaluate OCA prescriptions in hospital. These prescriptions are current, often uninterpretable and mostly ordered until patient discharge. Such drug orders could be associated with an increased risk of iatrogenic events and/or administration errors. This underlies the need for developing decision support tools and computerized protocols to manage hypertension urgencies.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

Section: What Is K Nown and Objec Tivementioning

confidence: 99%