SHM Converge Scientific Abstract ePoster Gallery-Decreasing Use of as-Needed Anti-Hypertensives in Hospitalized Patients With Asymptomatic Hypertension

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This project evaluated whether a multi-modal intervention could reduce the use of as-needed (PRN) antihypertensives in hospitalized adults with asymptomatic hypertension. The background notes that although hypertension is common, hypertensive emergency is rare, and guidelines recommend treating emergencies but not asymptomatic elevated blood pressure in the acute inpatient setting. PRN antihypertensives can cause harm, including hypotension, acute kidney injury, myocardial infarction, and stroke.<br /><br />The study included adult patients on medical services at an academic hospital and compared a pre-intervention period (July–September 2021) with a post-intervention period (December 2021–February 2022). The intervention combined staff education, a clinical algorithm poster, a survey/knowledge assessment, and electronic health record changes that removed PRN antihypertensives from admission orders and raised blood pressure notification thresholds.<br /><br />Before the intervention, PRN use was common enough to warrant improvement efforts: 15% of patients without hypertensive emergency had PRN orders, and 4% received at least one dose. Most PRN doses were intravenous, especially labetalol and hydralazine, contributing substantial cost. Survey results showed differences in practice beliefs: providers were more comfortable than nurses and pharmacists with not treating asymptomatic severe hypertension. Nurses often gave PRN medication to treat blood pressure, while providers sometimes used it to avoid workflow disruption or prevent pages.<br /><br />The project also showed questionable clinical benefit from PRN treatment: 25% of patients had no change or increased blood pressure after treatment, and 10% experienced a severe drop in blood pressure.<br /><br />Overall, the study aimed to decrease PRN antihypertensive administration, adverse events, and costs through education and system-level changes, highlighting the need to align inpatient blood pressure management with evidence-based guidelines.

Asset Subtitle

Kirsten M. Lipps

Meta Tag

Author List Allison Samuel, Deval Patel, Jeffrey Fish, Jordan Kenik, Kirsten M. Lipps, Lauren Fanta, Priya Roy

Category Innovations

Concept Asymptomatic Hypertension

Concept As-Needed Antihypertensives

Concept Hypertensive Emergency

Concept Multicomponent Intervention

Concept Adverse Events

Distinguished Non-Finalist

Presenter Organization University of Wisconsin Hospital & Clinics

Presenting Author Kirsten M. Lipps

Track Quality Improvement

Keywords

asymptomatic hypertension

PRN antihypertensives

hospitalized adults

multi-modal intervention

blood pressure management

inpatient guidelines

labetalol

hydralazine

electronic health record

adverse events

Asymptomatic Hypertension

As-Needed Antihypertensives

Hypertensive Emergency

Multicomponent Intervention

Adverse Events