• Andrew Posen, Scott Benken, Stephanie Dwyer Kaluzna, Murrah Sabouni, Jane Miglo, Jiaqi Cai, and Renee Petzel Gimbar.
• University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, S Wood St. 164 Pharm, MC 886, Chicago, IL 60612, United States; University of Illinois Hospital and Health Sciences System, 1740 W Taylor, St. Chicago, IL 60612, United States. Electronic address: posen2@uic.edu.
• Am J Emerg Med. 2022 Jan 1; 51: 46-52.

BackgroundThe American College of Cardiology and American Heart Association define hypertensive emergency (HTN-E) as a systolic blood pressure greater than 180 mmHg or a diastolic blood pressure greater than 120 mmHg with evidence of end-organ damage (EOD). Based on expert opinion, current guidelines recommend antihypertensive therapy to reduce blood pressure (BP) at specific hourly rates to reduce progression of EOD, outlined by four criteria. Our goal was to describe compliance with guideline recommendations for early management of HTN-E and to analyze safety outcomes related to pharmacologic intervention.MethodsThis was a retrospective chart review including patients presenting to the emergency department with HTN-E between September 2016 and August 2020. We excluded patients with a compelling indication for altered therapeutic goals (e.g. acute aortic dissection, hemorrhagic or ischemic stroke, and pheochromocytoma). The primary outcome was complete adherence with guideline recommendations in the first 24 h.ResultsOf 758 screened records, 402 were included. Mean age was 54 years and majority Black race (72%). Overall, total adherence was poor (<1%): 30% received intravenous therapy within 1 h, 64% achieved 1-h BP goals, 44% achieved 6-h goals, and 9% had appropriate 24-h maintenance BP. Hypotensive events (N = 67) were common and antihypertensive-associated EOD (N = 21) did occur. Predictors of hypotension include treatment within 1 h and management with continuous infusion medication.ConclusionsCurrent practice is poorly compliant with guideline criteria and there are risks associated with recommended treatments. Our results favor relaxing the expert opinion-based recommendations.Copyright © 2021 Elsevier Inc. All rights reserved.

34 keywords...

hide…