Assess Before Rx: Reducing the Overtreatment of Asymptomatic Blood Pressure Elevation in the Inpatient Setting

BACKGROUND Asymptomatic blood pressure elevation is common in the inpatient setting. National guidelines recommend treating with oral agents to slowly decrease blood pressure; however, many clinicians use intravenous antihypertensive medications, which can lead to unpredictable changes in blood pressure. OBJECTIVE To decrease the number of inappropriate orders (without symptoms of hypertensive emergency or order for NPO) of intravenous antihypertensives and adverse events associated with intravenous orders. DESIGN Quasi‐experimental study with multidisciplinary intervention. PARTICIPANTS Inpatients with a one‐time order for an intravenous antihypertensive agent from January 2016 to February 2018. MAIN MEASURES The main outcomes were the total numbers of orders and inappropriate orders, adverse events, and alternate etiologies per 1,000 patient‐days. As a balancing measure, patients were monitored for adverse events when blood pressure was elevated and not treated. KEY RESULTS There were a total of 260 one‐time orders of intravenous antihypertensives on two medical units. Inappropriate orders decreased from 8.3 to 3.3 per 1,000 patient days ( P = .0099). Adverse events associated with intravenous antihypertensives decreased from 3.7 to 0.8 per 1,000 patient days ( P = .0072). CONCLUSION This initiative demonstrated a significant reduction in inappropriate use of IV antihypertensives and an associated reduction in adverse events.