SEATTLE – About a third of the patients who received intravenous bolus antihypertensives in the emergency department at the Detroit Receiving Hospital did not need them, according to the results of a retrospective review at the 340-bed level 1 trauma center.
The findings were presented at the annual meeting of the American College of Emergency Physicians.
Dr. Suprat Saely
Of the 295 patients in the study, all had blood pressure of at least 180/110 mm Hg, but 95 did not have signs and symptoms of end-organ damage and had failed on oral therapy. These patients received no further workup or diagnosis related to acute hypertension after being given at least one IV push of, most commonly, labetalol. Atropine was needed to correct subsequent bradycardia in 1 of those 95 patients, and vasopressors in 1 of 2 patients who became hypotensive.
"A lot of physicians jump the gun and treat the number, not the patient," but in the absence of hypertensive emergencies, patients "can get away with oral therapy. You really don’t want to drop their blood pressure too quickly; you just want to bring them down slowly to their normal," which may only be a bit below their presenting pressure, said Suprat Saely, Pharm. D., an emergency department pharmacist at the hospital.
For the study, pharmacy orders were matched to patient medical records. There were no statistical differences in survival to discharge and 30-day revisits to the ED between the 200 patients treated appropriately and the 95 who were unnecessarily given IV antihypertensives.
These days, "as soon as I get these orders, I assess whether or not they are appropriate. Usually they are, but if not, I’ll go ask the physician if they really meant to order it," said Dr. Saely, who had no disclosures.