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Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage

BACKGROUND: Treatment of severe inpatient hypertension (HTN) that develops during hospitalization is not informed by guidelines. Intravenous (i.v.) antihypertensives are used to manage severe HTN even in the absence of acute target organ damage; however they may result in unpredictable blood pressur...

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Autores principales: Ghazi, Lama, Li, Fan, Simonov, Michael, Yamamoto, Yu, Nugent, James T., Greenberg, Jason H., Bakhoum, Christine Y., Peixoto, Aldo J., Wilson, F. Perry
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799038/
https://www.ncbi.nlm.nih.gov/pubmed/36583354
http://dx.doi.org/10.1097/HJH.0000000000003328
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author Ghazi, Lama
Li, Fan
Simonov, Michael
Yamamoto, Yu
Nugent, James T.
Greenberg, Jason H.
Bakhoum, Christine Y.
Peixoto, Aldo J.
Wilson, F. Perry
author_facet Ghazi, Lama
Li, Fan
Simonov, Michael
Yamamoto, Yu
Nugent, James T.
Greenberg, Jason H.
Bakhoum, Christine Y.
Peixoto, Aldo J.
Wilson, F. Perry
author_sort Ghazi, Lama
collection PubMed
description BACKGROUND: Treatment of severe inpatient hypertension (HTN) that develops during hospitalization is not informed by guidelines. Intravenous (i.v.) antihypertensives are used to manage severe HTN even in the absence of acute target organ damage; however they may result in unpredictable blood pressure (BP) reduction and cardiovascular events. Our goal was to assess the association between i.v. antihypertensives and clinical outcomes in this population. METHODS: This is a multihospital retrospective study of adults admitted for reasons other than HTN who develop severe HTN during hospitalization without acute target end organ damage. We defined severe HTN as BP elevation of systolic >180 or diastolic >110 mmHg. Treatment was defined as receiving i.v. antihypertensives within 3 h of BP elevation. We used overlap propensity score weighted Cox models to study the association between treatment and clinical outcomes during index hospitalization. RESULTS: Of 224 265 unique, nonintensive care unit hospitalizations, 20 383 (9%) developed severe HTN, of which 5% received i.v. antihypertensives and 79% were untreated within 3 h of severe BP elevation. In the overlap propensity weighted population, patients who received i.v. antihypertensives were more likely to develop myocardial injury (5.9% in treated versus 3.6% in untreated; hazard ratio [HR]: 1.6 [1.13, 2.24]). Treatment was not associated with increased risk of stroke (HR: 0.7 [0.3, 1.62]), acute kidney injury (HR: 0.97 [0.81, 1.17]), or death (HR: 0.86 [0.49, 1.51]). CONCLUSIONS: Intravenous antihypertensives were associated with increased risk of myocardial injury in patients who develop severe HTN during hospitalization. These results suggest that i.v. antihypertensives should be used with caution in patients without acute target organ damage.
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spelling pubmed-97990382023-01-04 Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage Ghazi, Lama Li, Fan Simonov, Michael Yamamoto, Yu Nugent, James T. Greenberg, Jason H. Bakhoum, Christine Y. Peixoto, Aldo J. Wilson, F. Perry J Hypertens Original Articles BACKGROUND: Treatment of severe inpatient hypertension (HTN) that develops during hospitalization is not informed by guidelines. Intravenous (i.v.) antihypertensives are used to manage severe HTN even in the absence of acute target organ damage; however they may result in unpredictable blood pressure (BP) reduction and cardiovascular events. Our goal was to assess the association between i.v. antihypertensives and clinical outcomes in this population. METHODS: This is a multihospital retrospective study of adults admitted for reasons other than HTN who develop severe HTN during hospitalization without acute target end organ damage. We defined severe HTN as BP elevation of systolic >180 or diastolic >110 mmHg. Treatment was defined as receiving i.v. antihypertensives within 3 h of BP elevation. We used overlap propensity score weighted Cox models to study the association between treatment and clinical outcomes during index hospitalization. RESULTS: Of 224 265 unique, nonintensive care unit hospitalizations, 20 383 (9%) developed severe HTN, of which 5% received i.v. antihypertensives and 79% were untreated within 3 h of severe BP elevation. In the overlap propensity weighted population, patients who received i.v. antihypertensives were more likely to develop myocardial injury (5.9% in treated versus 3.6% in untreated; hazard ratio [HR]: 1.6 [1.13, 2.24]). Treatment was not associated with increased risk of stroke (HR: 0.7 [0.3, 1.62]), acute kidney injury (HR: 0.97 [0.81, 1.17]), or death (HR: 0.86 [0.49, 1.51]). CONCLUSIONS: Intravenous antihypertensives were associated with increased risk of myocardial injury in patients who develop severe HTN during hospitalization. These results suggest that i.v. antihypertensives should be used with caution in patients without acute target organ damage. Lippincott Williams & Wilkins 2023-02 2022-11-18 /pmc/articles/PMC9799038/ /pubmed/36583354 http://dx.doi.org/10.1097/HJH.0000000000003328 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Articles
Ghazi, Lama
Li, Fan
Simonov, Michael
Yamamoto, Yu
Nugent, James T.
Greenberg, Jason H.
Bakhoum, Christine Y.
Peixoto, Aldo J.
Wilson, F. Perry
Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage
title Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage
title_full Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage
title_fullStr Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage
title_full_unstemmed Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage
title_short Effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage
title_sort effect of intravenous antihypertensives on outcomes of severe hypertension in hospitalized patients without acute target organ damage
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799038/
https://www.ncbi.nlm.nih.gov/pubmed/36583354
http://dx.doi.org/10.1097/HJH.0000000000003328
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