Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

Campos, Claudia L.; Herring, C. T.; Ali, Nora’aini; Jones, Deanna N.; Wofford, James L.; Caine, Augustus; Bloomfield, Robert; Tillett, Janine; Oles, Karen S.

doi:10.1007/s11606-017-4277-6

Cited by 12 publications

(15 citation statements)

References 41 publications

(66 reference statements)

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“…This point requires further investigation, as we were unable to evaluate therapeutic modifications transferred at discharge with our local clinical data warehouse. Besides, OCA prescriptions are frequently given for patients admitted for reasons other than hypertension and initiated for a patient with no history of hypertension at the time of hospitalization . However, our subgroup analysis suggested that the probability of modification of a chronic treatment after OCA prescription during hospitalization was frequent.…”

Section: Resultsmentioning

confidence: 99%

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%

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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“…с последующей коррекцией режима приема препаратов длительного действия [37][38][39]. В качестве такого перорального короткодействующего средства может быть использован каптоприл, эффективность и безопасность которого в данной ситуации хорошо изучена в том числе у пациентов пожилого возраста [40,41].…”

Section: Arterial Hypertension In Older Patientsunclassified

Arterial hypertension and antihypertensive therapy in older patients. The agreed opinion of experts from the Russian Association of Gerontologists and Geriatricians, the Antihypertensive League, the National Society for Preventive Cardiology

Ткачева¹,

Kotovskaya²,

Рунихина³

et al. 2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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High blood pressure is a risk factor for cardiovascular morbidity and mortality, as well as cognitive decline and loss of autonomy in the elderly and old age. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy indicate the benefit of lowering elevated blood pressure in patients over 80 years of age. Older patients with senile asthenia, loss of autonomy and other geriatric problems were excluded from RCTs, and observational studies in these groups of patients indicate an increase in morbidity and mortality with lower blood pressure and antihypertensive therapy. Obviously, in very elderly patients, a universal strategy for the treatment of arterial hypertension cannot be applied due to the significant heterogeneity of their functional status. The geriatric approach to the management of arterial hypertension in older patients involves an assessment of the functional status, the presence of senile asthenia, and the degree of autonomy for the choice of antihypertensive therapy tactics.

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“…Каптоприл применялся в дозах 6,25-25 мг перорально или сублингвально, дозозависимый гипотензивный эффект отмечался в течение 0,17-12 ч с момента приема. Следует отметить, что каптоприл был единственным ингибитором ангиотензинпревращающего фермента, который изучался в ходе рандомизированных клинических исследований у пациентов с нГК [13].…”

Section: заключение совета экспертовunclassified

Emergency care in a sudden individually significant blood pressure increase without clinically overt target organ damage: rationale for captopril use. Expert Council opinion

et al. 2020

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Expert Council opinion describes emergency care in a sudden individually significant blood pressure (BP) increase without clinically overt target organ damage. In the new guidelines of the Russian Society of Cardiology, the term “hypertensive urgency” was abolished, and the management of a sudden BP increase was changed. At the same time, a sudden individually significant BP increase may be accompanied by symptoms that reduce patients’ quality of life and ability to work. According to experts, individually significant BP increase accompanied by symptoms requires outpatient treatment using oral rapid-onset drugs with an optimal duration of action, in particular captopril. It has a much evidence-based data on the BP increase use and sublingual administration, and also has a favorable safety profile, which allows prescribing to patients with comorbid diseases. The rationale for the use of angiotensin-converting enzyme inhibitor Capoten (captopril) as a drug for self-management of a sudden individually significant BP increase accompanied by symptoms in hypertension patients is describes.

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Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

Cited by 12 publications

References 41 publications

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

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

Arterial hypertension and antihypertensive therapy in older patients. The agreed opinion of experts from the Russian Association of Gerontologists and Geriatricians, the Antihypertensive League, the National Society for Preventive Cardiology

Emergency care in a sudden individually significant blood pressure increase without clinically overt target organ damage: rationale for captopril use. Expert Council opinion

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