Priya Shah, BCPS, PharmD
Christiana Care Health System
Newark, Delaware, United States
Disclosure information not submitted.
Justina Girgis, PharmD, BCCCP
Critical Care Pharmacist
Robert Wood Johnson University Hospital Somerset
Boston, Massachusetts, United States
Disclosure information not submitted.
Deepali Dixit, BCCCP, BCPS, PharmD
Clinical Associate Professor
Robert Wood Johnson University Hospital
New Brunswick, NJ
Disclosure information not submitted.
Luigi Brunetti, PharmD, MPH, BCPS, BCGP
Clinical Pharmacy Specialist
Robert Wood Johnson University Hospital Somerset, United States
Disclosure information not submitted.
Christopher Adams, BCCCP, BCPS, PharmD (he/him/his)
Associate Director Medical Affairs
Rutgers Ernest Mario School of Pharmacy
FREEHOLD, New Jersey, United States
Disclosure information not submitted.
Title: Effect of Initial Intravenous Antihypertensive in Hypertensive Emergencies: a Multicenter Analysis
INTRODUCTION/HYPOTHESIS: Hypertensive crisis is defined by a systolic blood pressure greater than 180 mmHg or a diastolic blood pressure greater than 120 mmHg. A subset of hypertensive crisis, hypertensive emergency is characterized by end organ damage and requires rapid blood pressure control with intravenous (IV) antihypertensives. Few studies have been conducted which compare the various IV antihypertensive agents and determine optimal therapy. This study evaluated agents commonly used for hypertensive emergency and their effect on clinical outcomes.
Methods: Multicenter retrospective chart review including adult patients with hypertensive emergency given at least one dose of an IV antihypertensive in the emergency department. Pregnancy, stroke, and aortic dissection were excluded. As labetalol was the most commonly used IV antihypertensive agent, the primary outcome was the amount of time to goal mean arterial pressure (MAP) when using IV labetalol compared to other IV antihypertensives. Goal MAP was defined as a reduction of 25% from initial measurement unless otherwise documented. Secondary outcomes included the percentage of MAPs at goal during the first 24 hours of hospitalization, number of IV antihypertensives used, and duration of IV therapy.
Results: Eighty patients were studied, 42 (52.5%) in the labetalol group and 38 (47.5%) in the non-labetalol group. There was no significant difference in the primary outcome, time to goal MAP at 1 hour (42.9% vs 34.2%; p=0.43), 6 hours (47.6% vs 52.6%; p=0.65), or more than 6 hours (9.5% vs 13.2%; p=0.61). There was also no significant difference for the duration of IV antihypertensive therapy at 24 (p=0.20), 48 (p=0.61), or greater than 48 hours (p=0.30). The proportion of patients that had at least two-thirds, 66.7% of MAPs at goal during the first 24 hours was greater in the labetalol group (59.5% vs 36.8%; p< 0.05). Additionally, 61.9% of patients receiving labetalol as first line only required up to one dose titration versus 39.4% in the comparator group (p < 0.05).
Conclusions: There was no significant difference in time to goal MAP or duration of IV therapy. Use of labetalol may allow for achievement of goal MAP over a longer duration in the first 24 hours. A superior IV antihypertensive for the management of hypertensive emergency is yet to be identified.