Evidence of an ischemic penumbra in patients with acute stroke. Blood flow and vascular reactivity in collaterally perfused brain tissue.
Olsen TS, Larsen B, Herning M, Skriver EB, Lassen NA. Border zone infarcts: pathophysiologic and imaging characteristics. doi: 10.1056/NEJMra064398 Crossref Medline Google Scholar Normotensive ischemic acute renal failure. doi: 10.1002/jhm.2510 Crossref Medline Google Scholar As-needed intravenous antihypertensive therapy and blood pressure control. Lipari M, Moser LR, Petrovitch EA, Farber M, Flack JM. doi: 10.1111/j. Crossref Medline Google Scholar Treatment of hypertension in the inpatient setting: use of intravenous labetalol and hydralazine. Intravenous hydralazine for blood pressure management in the hospitalized patient: its use is often unjustified. Campbell P, Baker WL, Bendel SD, White WB. doi: 10.1007/s1188-y Crossref Medline Google Scholar
PRO RE NATA TAKE AS NEEDED CD UPDATE
An update on inpatient hypertension management. Treating acute hypertension in the hospital: a Lacuna in the guidelines. doi: 10.1002/jhm.804 Crossref Medline Google Scholar Prevalence and management of hypertension in the inpatient setting: a systematic review. doi: 10.5811/westjem.200 Crossref Medline Google Scholar Appropriateness of bolus antihypertensive therapy for elevated blood pressure in the Emergency Department. Miller JB, Arter A, Wilson SS, Janke AT, Brody A, Reed BP, Levy PD. Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort. Levy PD, Mahn JJ, Miller J, Shelby A, Brody A, Davidson R, Burla MJ, Marinica A, Carroll J, Purakal J, et al. doi: 10.1001/jamainternmed.2016.1509 Crossref Medline Google Scholar Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting. Patel KK, Young L, Howell EH, Hu B, Rutecki G, Thomas G, Rothberg MB. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, et al. doi: 10.1056/NEJMcp1901117 Crossref Medline Google Scholar We suggest that the routine use of as needed antihypertensive medication should be discouraged. The use of as needed antihypertensive medication is associated with an abrupt drop in BPs, increased risk of ischemic events, in-hospital mortality, and longer length of stay. In addition, ischemic events were more likely in those who had an abrupt drop in BPs, and the risk was increased in proportion to the number of doses of as needed BP medications administered. The use of as needed antihypertensive medication was also associated with increased in-hospital mortality (odds ratio, 2.36 P=0.001) and an increase in the median length of stay (4.7 versus 2.9 days P<0.001). Compared with the propensity-matched cohort, patients who received antihypertensive medications on an as needed basis were more likely to experience abrupt lowering of systolic BPs (odds ratio, 2.05, P<0.001), acute kidney injury (odds ratio, 1.24, P=0.002), and ischemic stroke (odds ratio, 8.5 P<0.001). Four thousand two hundred nineteen patients who received BP medications on an as needed basis in addition to scheduled antihypertensive medications were matched 1:1 using propensity matching to those who received only scheduled BP medications. We hypothesized that treatment of inpatients, who do not have a hypertensive emergency, with the use of antihypertensive medication on an as needed basis could lead to adverse outcomes.
PRO RE NATA TAKE AS NEEDED CD PRO
Physicians routinely order blood pressure (BP) medications on an as needed basis or pro re nata to control BPs in hospitalized patients.
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