Risk factors for adverse events during hypertension management in the emergency department: a comparison of intravenous antihypertensive therapies

Introduction:

Initial therapy for elevated blood pressure (BP) in the emergency department (ED) is aimed at lowering BP gradually to avoid rapid changes in tissue perfusion and the development of ischemia. Drops in BP leading to hypotension should be avoided as hypotension in the ED has been shown to be an independent predictor of inpatient mortality. To date, there are no published guidelines or literature to recommend one antihypertensive agent over another in this setting.

Objectives:

The primary objective is to determine the effect of individual IV antihypertensive agents on the development of adverse events during hypertension management in the ED. Adverse events are defined as the occurrence of any of the following after antihypertensive administration: decrease in mean arterial blood pressure (MAP) greater than 25% within first two hours; systolic blood pressure less than 100 mmHg; need for vasopressor support or fluid resuscitation; or development of acute kidney injury (AKI) as defined by Acute Kidney Injury Network (AKIN) criteria. Secondary objectives include characterization of the treatment of elevated BP in the TUH ED and the incidence and type of adverse events according to antihypertensive agent.

Study Design:

This is a single center, retrospective chart review.

Methods:

Subjects included are adult patients admitted to the ED who received any IV antihypertensive agent for the treatment of elevated BP. Exclusion criteria include: age less than 18 years; hospital length of stay less than 48 hours; or diagnosis of aortic dissection, intracranial hemorrhage, myocardial infarction, or ischemic stroke.

Results:

To date, 68 patients have been screened with 20 included. The average age is 55.9 years. IV medications utilized thus far are labetalol, nitroglycerin, enalaprilat, and nicardipine. There were 13 incidences of adverse events: MAP decrease greater than 25% in 7 patients (1 requiring fluid resuscitation) and AKI in 5 patients.

Conclusions:

N/A