Quality Improvement Project Aims to Decelerate Aggressive Hypertension Treatment

By Jonathan Springston, Editor, Relias Media

Researchers in a New York City (NYC) health system made tiny procedural changes that dramatically affected when and why staff administered intravenous (IV) antihypertensive medication.

Although hypertension is a serious condition that needs attention, it is important to be cautious about treating hospitalized patients’ high blood pressure too aggressively. Investigators have found some protective benefit in administering IV antihypertensive medications to pregnant women who record blood pressure readings of 140/90 mmHg. Clinicians might call for this treatment to prevent end-organ damage or failure; however, researchers have found aggressive antihypertensive treatment to be associated with negative outcomes in some cases, including but not limited to: stroke, acute aortic dissection, and intracerebral hemorrhage.

At NYC Health + Hospitals, investigators recently made two changes to electronic orders for IV hydralazine and IV labetalol, common antihypertensive medications administered in the hospital: a nonintrusive advisory statement within the order instructions and a mandatory requirement to document the indication for IV antihypertensive use.

From November 2021 to October 2022, for ED-only encounters, aggregate IV hydralazine and IV labetalol orders per 1,000 patient encounters were 2.53 before the intervention and 1.55 after the intervention (38.7% reduction). For inpatient encounters, aggregate IV hydralazine and IV labetalol orders per 1,000 patient-days were 18.25 before the intervention and 15.81 after the intervention (13.4% reduction).

The authors observed similar trends for individual orders of IV hydralazine and IV labetalol. They reported significant reductions in seven of the 11 hospitals in inpatient administration of aggregate IV hydralazine and labetalol orders per 1,000 patient-days.

“We found that two small prompts in our electronic health record had a dramatic impact on reducing IV antihypertensive orders,” said Mona Krouss, MD, assistant vice president of value and patient safety at NYC Health + Hospitals and lead author of the study. “By reducing unnecessary antihypertensive IV use, this low effort intervention likely had an impact on decreasing adverse events."

For more on this and related subjects, be sure to read the latest issues of Clinical Cardiology Alert, Critical Care Alert, ED Management, Emergency Medicine Reports, and Primary Care Reports.