Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department

Miller, Joseph; Arter, A.; Wilson, Suprat Saely; Janke, Alexander T.; Brody, Aaron; Reed, Brian; Levy, Phillip D.

doi:10.5811/westjem.2017.5.33410

Cited by 9 publications

(14 citation statements)

References 14 publications

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“…The final result set included 10 articles for qualitative synthesis. 8,[11][12][13][14][15][16][17][18][19]…”

Section: Re Sultsmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

“…Of 10 articles identified through the systematic review process (Table 1), nine (90%) 8,[11][12][13][14][16][17][18][19] were conducted in the United States, and one (10%) 15 in Switzerland. The publication dates ranged from 1984 to 2019, with three (30%) [15][16][17] published in the 1980s and seven (70%) 8,[11][12][13][14]18,19 published from 2010 to 2019. Five studies (50%) 8,[11][12][13][14] evaluated both labetalol and hydralazine, four (40%) [15][16][17][18] focused on labetalol alone, and one study (10%) 19 on hydralazine alone.…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

“…The publication dates ranged from 1984 to 2019, with three (30%) [15][16][17] published in the 1980s and seven (70%) 8,[11][12][13][14]18,19 published from 2010 to 2019. Five studies (50%) 8,[11][12][13][14] evaluated both labetalol and hydralazine, four (40%) [15][16][17][18] focused on labetalol alone, and one study (10%) 19 on hydralazine alone. The study designs of identified articles were diverse, including five retrospective cohorts (50%), 8,[11][12][13]18 two prospective cohorts (20%), 16,19 two openlabel experimental studies (20%) 15,17 and one quasi-experimental study (10%).…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

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Safety and efficacy of intravenous hydralazine and labetalol for the treatment of asymptomatic hypertension in hospitalised patients: A systematic review

et al. 2021

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Background: Current guidelines for the management of asymptomatic hypertension (HTN) in the inpatient setting recommend the use of oral antihypertensives. However, in clinical practice, intravenous (IV) antihypertensives are commonly utilised with little supporting evidence. The objective of this study was to evaluate literature examining the safety/efficacy of IV hydralazine and labetalol in hospitalised patients with non-emergent, asymptomatic HTN. Methods:The PRISMA guidelines were utilised to structure the systematic review.A search strategy composed of drug-, inpatient-and HTN-related terms was conducted utilising PubMed, Embase and Scopus databases through May 2020.Full-text, English-language articles describing IV labetalol and/or hydralazine use for non-emergent HTN in an inpatient setting that focused on clinical outcomes (ie vitals, adverse effects, healthcare utilisation) were included. Identified studies were screened/extracted using DistillerSR by two reviewers at each stage, and studies were evaluated qualitatively for the presence of bias.Results: From 3362 records identified in the search, a final set of 10 articles were identified. Four studies focused on labetalol (40%), five studies on hydralazine and labetalol (50%), and one study on hydralazine (10%). The included studies presented a variety of outcomes, but several trends were identified, including reduction in average blood pressure in eight (80%) studies, a risk of adverse effects in six (60%) and increased length of stay in one (10%). Discussion:The studies identified in this review raise concerns regarding the safety of IV hydralazine and labetalol in non-emergent HTN. Despite relatively broad clinical experience with these drugs, experimental investigations regarding their utility are recommended.

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“…The final result set included 10 articles for qualitative synthesis. 8,[11][12][13][14][15][16][17][18][19]…”

Section: Re Sultsmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Safety and efficacy of intravenous hydralazine and labetalol for the treatment of asymptomatic hypertension in hospitalised patients: A systematic review

et al. 2021

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“…Given the aforementioned variability in clinical practice, it is not surprising that the majority of IV medications given to achieve immediate BP reduction in the ED are done so inappropriately to patients without new or worsening end-organ injury that can be modified by rapid treatment. 15 …”

Section: Assessing and Treating Hypertensive Emergenciesmentioning

confidence: 99%

Hypertension Management in Emergency Departments

Miller

McNaughton

Joyce

et al. 2020

American Journal of Hypertension

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BACKGROUND Elevated blood pressure (BP) is pervasive among patients that visit emergency departments (EDs) for their care. METHODS In this review article, we outline the current approach to the management of these individuals and highlight the crucial role emergency medicine clinicians play in reducing the morbidity associated with elevated BP. RESULTS We highlight the critical importance of immediate treatment when elevated BP contributes to new or worsening end-organ injury but emphasize that such hypertensive emergencies are rare. For the vast majority of patients with elevated BP in the ED who do not have new or worsening end-organ injury from elevated BP, immediate BP reduction within the ED is not recommended or safe. Nonetheless, within weeks after an ED visit, there is a pressing need to improve the care of patients with elevated or previously undiagnosed hypertension. For many, it may be their only regular point of engagement with the healthcare system. To address this, we present novel perspectives that envision a new role for emergency medicine in chronic hypertension management—one that acknowledges the significant population-level gaps in BP control that contribute to disparities in cardiovascular disease and sets the stage for future changes in systems-based practice. CONCLUSIONS Emergency medicine plays a key and evolving role in reducing morbidity associated with elevated BP.

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Institutional Pathways to Improve Care of Patients with Elevated Blood Pressure in the Emergency Department

et al. 2018

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Results from the recent SPRINT trial, and the subsequent publication of the American Heart Association updated guidelines for the treatment of HTN, significantly lower both the diagnostic threshold and the treatment goals for hypertensive patients. This change will drastically increase the proportion of patients presenting to EDs with newly diagnosed and uncontrolled HTN. Several recent studies emphasize the safety in outpatient management of patients with severely elevated BP in the absence of acute end-organ damage and, conversely, the long- and intermediate-term risk associated with these patients. System-based approaches, particularly those led by non-physicians, have shown the greatest promise in reducing population level uncontrolled HTN. Evidence-based approaches, such as those described in emergency medicine and cardiology society guidelines, can guide appropriate management of ED and inpatient BP elevations. Translating these patient oriented guidelines into institutional policy, and maintaining provider adherence, is a challenge across healthcare institutions. We present here several examples of successful policies developed and implemented by the authors. While brief inpatient and ED encounters cannot replace long-term outpatient care, they have the potential to serve as a crucial inlet to health care and an opportunity to optimize care.

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Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department

Cited by 9 publications

References 14 publications

Safety and efficacy of intravenous hydralazine and labetalol for the treatment of asymptomatic hypertension in hospitalised patients: A systematic review

Safety and efficacy of intravenous hydralazine and labetalol for the treatment of asymptomatic hypertension in hospitalised patients: A systematic review

Hypertension Management in Emergency Departments

Institutional Pathways to Improve Care of Patients with Elevated Blood Pressure in the Emergency Department

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