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Reducing Unnecessary Treatment of Asymptomatic Elevated Blood Pressure with Intravenous Medications on the General Internal Medicine Wards: A Quality Improvement Initiative
Author(s) -
Jacobs Zachary G,
Najafi Nader,
Fang Margaret C,
Prasad Priya A,
AbeJones Yumiko,
Auerbach Andrew D,
Patel Sajan
Publication year - 2019
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3087
Subject(s) - medicine , asymptomatic , hospital medicine , blood pressure , retrospective cohort study , intensive care unit , odds ratio , cohort , emergency medicine
BACKGROUND Asymptomatic elevated blood pressure (BP) is common in the hospital. There is no evidence supporting the use of intravenous (IV) antihypertensives in this setting. OBJECTIVE To determine the prevalence and effects of treating asymptomatic elevated BP with IV antihypertensives and to investigate the efficacy of a quality improvement (QI) initiative aimed at reducing utilization of these medications. DESIGN Retrospective cohort study. SETTING Urban academic hospital. PATIENTS Patients admitted to the general medicine service, including the intensive care unit (ICU), with ≥1 episode of asymptomatic elevated BP (>160/90 mm Hg) during hospitalization. INTERVENTION A two‐tiered, QI initiative. MEASUREMENTS The primary outcome was the monthly proportion of patients with asymptomatic elevated BP treated with IV labetalol or hydralazine. We also analyzed median BP and rates of balancing outcomes (ICU transfers, rapid responses, cardiopulmonary arrests). RESULTS We identified 2,306 patients with ≥1 episode of asymptomatic elevated BP during the 10‐month preintervention period, of which 251 (11%) received IV antihypertensives. In the four‐month postintervention period, 70 of 934 (7%) were treated. The odds of being treated were 38% lower in the postintervention period after adjustment for baseline characteristics, including length of stay and illness severity (OR = 0.62; 95% CI 0.47‐0.83; P = .001). Median SBP was similar between pre‐ and postintervention (167 vs 168 mm Hg; P = .78), as were the adjusted proportions of balancing outcomes. CONCLUSIONS Hospitalized patients with asymptomatic elevated BP are commonly treated with IV antihypertensives, despite the lack of evidence. A QI initiative was successful at reducing utilization of these medications.