1
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Tsang JNJ, Bacchi S, Ovenden CD, Goh R, Kovoor JG, Gupta AK, Min Le Y, Lam A, Stretton B, To MS, Woodman R, Mangoni AA, Malycha J. Meeting medical emergency response criteria for hypertension is not associated with an increased likelihood of in-hospital mortality in a tertiary referral center. Resusc Plus 2024; 19:100679. [PMID: 38912533 PMCID: PMC11190537 DOI: 10.1016/j.resplu.2024.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Backgrounds Rapid response team or medical emergency team (MET) calls are typically activated by significant alterations of vital signs in inpatients. However, the clinical significance of a specific criterion, blood pressure elevations, is uncertain. Objectives The aim of this study was to evaluate the likelihood ratios associated with MET-activating vital signs, particularly in-patient hypertension, for predicting in-hospital mortality among general medicine inpatients who met MET criteria at any point during admission in a South Australian metropolitan teaching hospital. Results Among the 15,734 admissions over a two-year period, 4282 (27.2%) met any MET criteria, with a positive likelihood ratio of 3.05 (95% CI 2.93 to 3.18) for in-hospital mortality. Individual MET criteria were significantly associated with in-hospital mortality, with the highest positive likelihood ratio for respiratory rate ≤ 7 breaths per minute (9.83, 95% CI 6.90 to 13.62), barring systolic pressure ≥ 200 mmHg (LR + 1.26, 95% CI 0.86 to 1.69). Conclusions Our results show that meeting the MET criteria for hypertension, unlike other criteria, was not significant associated with in-hospital mortality. This observation warrants further research in other patient cohorts to determine whether blood pressure elevations should be routinely included in MET criteria.
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Affiliation(s)
- Jin Nuo Joan Tsang
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide SA 5005, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide SA 5000, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide SA 5005, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide SA 5000, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide SA 5005, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide SA 5000, Australia
| | - Joshua G Kovoor
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide SA 5000, Australia
- Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville SA 5011, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide SA 5005, Australia
- Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Yong Min Le
- University of Adelaide, Adelaide SA 5005, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide SA 5000, Australia
| | - Antoinette Lam
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia
- University of Adelaide, Adelaide SA 5005, Australia
| | - Brandon Stretton
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia
- University of Adelaide, Adelaide SA 5005, Australia
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia
| | - Arduino A Mangoni
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia
- Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park SA 5042, Australia
| | - James Malycha
- University of Adelaide, Adelaide SA 5005, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide SA 5000, Australia
- Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville SA 5011, Australia
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2
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Ali N, Aftab U, Soomar SM, Tareen H, Khan UR, Khan BA, Razzak JA. Clinical utility of routine investigations and risk factors of end-organ damage in asymptomatic severe hypertension. Intern Emerg Med 2023; 18:2037-2043. [PMID: 37668749 DOI: 10.1007/s11739-023-03403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
Asymptomatic severe hypertension is defined as systolic blood pressure of ≥ 180 mmHg or diastolic blood pressure of ≥ 120 mmHg without signs and symptoms of end-organ damage or dysfunction. Literature shows that around 5% of the patients with severe asymptomatic hypertension had acute hypertension-related end-organ damage. This study aimed to determine the clinical utility of routine investigations and risk factors of end-organ damage in patients presented to the emergency department with asymptomatic severe hypertension. This single-center, cross-sectional study was conducted at the emergency department of the Aga Khan University Hospital, Karachi, Pakistan, from January 2018 to December 2020. All adult patients (age ≥ 18 years) presented to the emergency department with a systolic blood pressure of ≥ 180 or diastolic blood pressure of ≥ 120 mmHg without any signs and symptoms of end-organ damage (e.g., chest pain, unilateral limb or facial weakness, or hemiplegia, altered mental status, shortness of breath, decreased urine output, and sudden-onset of severe headache) were included. Routine investigations were analyzed to detect end-organ damage, including complete blood count, basic metabolic panel, urine detailed report, electrocardiogram, and troponin-I. Multivariable binary logistic regression was applied to identify the risk factors of end-organ damage considering the significant p value of ≤ 0.05. A total of 180 patients were presented to the emergency department with asymptomatic severe hypertension during the study period. Among the total patients, 60 patients (33.3%) had abnormal investigation findings; out of them, new-onset end-organ damage was diagnosed in 15 patients (8.3%). The most common end-organ damage was the kidney (73.3%) followed by the heart (26.6%). The multivariable binary logistic regression showed that age of more than 60 years, past medical history of diabetes, ischemic heart disease, and cerebrovascular accident were significantly associated with a higher risk of end-organ damage (p < 0.05). The study identified a higher prevalence of abnormal routine investigations and acute end-organ damage in emergency department patients with asymptomatic severe hypertension compared to high-income countries and suggested a lower threshold for end-organ damage screening in these patients. The current recommendations of foregoing further workup in patients with asymptomatic severe hypertension may need modification for emergency departments in low-middle-income countries if similar associations are replicated in other settings.
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Affiliation(s)
- Noman Ali
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan.
| | - Umaira Aftab
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Salman Muhammad Soomar
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Hafsa Tareen
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Badar Afzal Khan
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
- Weill Cornell Medicine,, New York, USA
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3
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Chun H, Zimmerman DE, Covvey JR, Nemecek BD. Initiation of oral antihypertensives in hospitalized patients with hypertensive urgency: A descriptive study. Am J Health Syst Pharm 2023; 80:S85-S96. [PMID: 36455870 DOI: 10.1093/ajhp/zxac357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
PURPOSE In hypertensive urgency, guidelines recommend oral antihypertensives, but with limited guidance on implementation. The objective of this study was to determine whether time to initiation of oral antihypertensives impacts blood pressure (BP) reduction in patients with hypertensive urgency. METHODS A descriptive study was conducted of adult hospitalized patients with hypertensive urgency from November 2018 through November 2021. Patients with a systolic BP (SBP) of 180 mm Hg or higher or a diastolic BP (DBP) of 120 mm Hg or higher and receipt of oral antihypertensives within 48 hours of presentation were included. The primary outcome was the percentage change in SBP from baseline at 12 to 24 hours and 24 to 48 hours. Secondary outcomes included the change in DBP and mean arterial pressure (MAP), time to 3 consecutive goal SBP readings, continuation of home oral antihypertensives, administration of intravenous (IV) antihypertensives, and length of stay (LOS). Patients were stratified by quartile (Q1 through Q4) based on time to first oral antihypertensive. RESULTS A total of 220 patients were included. A significant difference in SBP was observed among the quartiles, due to the greater sustained SBP reduction in Q1 at 12 to 24 hours and 24 to 48 hours (median [interquartile range, IQR], 22.9% [13.1%-30.5%] and 22.5% [IQR, 15.8%-32.9%] reduction, respectively). There were also reductions in DBP and MAP, with Q1 consistently having larger reductions than Q4. Patients in Q1 had 3 consecutive goal SBP readings earlier than those in the other quartiles (median [IQR], 13.1 [7.0-21.5] hours). Continuation of home medications, number of IV antihypertensives, and LOS did not differ among the quartiles. CONCLUSION In this analysis, earlier administration of oral antihypertensives was associated with a larger sustained reduction in SBP.
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Affiliation(s)
- Hannah Chun
- Massachusetts General Hospital, Boston, MA, USA
| | - David E Zimmerman
- UPMC Mercy Hospital, Pittsburgh, PA
- Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, PA, USA
| | - Jordan R Covvey
- Division of Pharmaceutical, Social, and Administrative Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA, USA
| | - Branden D Nemecek
- UPMC Mercy Hospital, Pittsburgh, PA
- Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, PA, USA
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Shahzad Qamar A, Zamir A, Khalid S, Ashraf W, Imran I, Hussain I, Rehman AU, Saeed H, Majeed A, Alqahtani F, Rasool MF. A review on the clinical pharmacokinetics of hydralazine. Expert Opin Drug Metab Toxicol 2022; 18:707-714. [PMID: 36150895 DOI: 10.1080/17425255.2022.2129005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hydralazine is a vasodilator used to treat hypertension, pre-eclampsia, and heart failure. The current article reviews the clinical pharmacokinetics (PK) of hydralazine, which can be useful for clinicians in optimizing its dose and dosing frequency to avoid adverse effects and unexpected interactions that could risk patients' lives. AREAS COVERED This review has summarized the PK parameters for hydralazine after performing an extensive literature search. It includes 20 publications that were selected after applying eligibility criteria out of a pool of literature that was searched using Google Scholar, PubMed, Cochrane Central, and EBSCO databases. The included studies consisted of concentration vs. time profiles of hydralazine. If the PK data were not tabulated in the given study, the concentration vs. time profiles were scanned for the extraction of the PK data. The PK parameters were calculated by applying a non-compartmental analysis (NCA). EXPERT OPINION The current review will aid clinicians in understanding hydralazine PK in different disease populations. This clinical PK data might also be helpful in the development of a pharmacokinetic model of hydralazine.
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Affiliation(s)
- Asma Shahzad Qamar
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan.,Both authors contributed equally
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan.,Both authors contributed equally
| | - Sundus Khalid
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan
| | - Iltaf Hussain
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan
| | - Anees Ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, Allama Iqbal Campus, University of the Punjab, 54000, Lahore, Pakistan
| | - Abdul Majeed
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, 60800, Multan, Pakistan
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Marshall RC, Thiel DJ, Samar H. Noncardiac inpatient has acute hypertension: Treat or not? THE JOURNAL OF FAMILY PRACTICE 2022; 71:314-316. [PMID: 36179135 PMCID: PMC9531623 DOI: 10.12788/jfp.0470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A retrospective study found more harm than benefit from treating elevated blood pressure in hospitalized noncardiac patients.
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Affiliation(s)
| | | | - Haroon Samar
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA
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6
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Ghazi L, Li F, Chen X, Simonov M, Yamamoto Y, Biswas A, Hanna J, Shah T, Peixoto AJ, Wilson FP. Blood pressure response to commonly administered antihypertensives for severe inpatient hypertension. PLoS One 2022; 17:e0265497. [PMID: 35385506 PMCID: PMC8985959 DOI: 10.1371/journal.pone.0265497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/02/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Blood pressure (BP) elevations are commonly treated in hospitalized patients; however, treatment is not guideline directed. Our objective was to assess BP response to commonly prescribed antihypertensives after the development of severe inpatient hypertension (HTN). METHODS This is a cohort study of adults, excluding intensive care unit patients, within a single healthcare system admitted for reasons other than HTN who developed severe HTN (systolic BP>180 or diastolic BP >110 mmHg at least 1 hour after admission). We identified the most commonly administered antihypertensives given within 6 hours of severe HTN (given to >10% of treated patients). We studied the association of treatment with each antihypertensive vs. no treatment on BP change in the 6 hours following severe HTN development using mixed-effects model after adjusting for demographics and clinical characteristics. RESULTS Among 23,147 patients who developed severe HTN, 9,166 received antihypertensive treatment. The most common antihypertensives given were oral metoprolol (n = 1991), oral amlodipine (n = 1812), oral carvedilol (n = 1116), IV hydralazine (n = 1069) and oral hydralazine (n = 953). In the fully adjusted model, treatment with IV hydralazine led to 13 [-15.9, -10.1], 18 [-22.2, -14] and 11 [-14.1, -8.3] mmHg lower MAP, SBP, and DBP in the 6 hours following severe HTN development compared to no treatment. Treatment with oral hydralazine and oral carvedilol also resulted in significantly lower BPs in the 6 hours following severe HTN development (6 [-9.1, -2.1 and -7 [-9.1, -4.2] lower MAP, respectively) compared to no treatment. Receiving metoprolol and amlodipine did not result in a drop in BP compared to no treatment. CONCLUSION Among commonly used antihypertensives, IV hydralazine resulted in the most significant drop in BP following severe HTN, while metoprolol and amlodipine did not lower BP. Further research to assess the effect of treatment on clinical outcomes and if needed which antihypertensives to administer are necessary.
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Affiliation(s)
- Lama Ghazi
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
- * E-mail:
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Xinyuan Chen
- Department of Mathematics and Statistics, Mississippi State University, Mississippi State, MS, United States of America
| | - Michael Simonov
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
| | - Yu Yamamoto
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
| | - Aditya Biswas
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
| | - Jonathan Hanna
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, United States of America
| | - Tayyab Shah
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, United States of America
| | - Aldo J. Peixoto
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, and the Hypertension Program, Yale New Haven Hospital Heart and Vascular Center, New Haven, CT, United States of America
| | - F. Perry Wilson
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, United States of America
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Clinical Evaluation of Pinggan Yiqi Yangshen Recipe Combined with Labetalol Hydrochloride and Magnesium Sulfate in the Treatment of PIH. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3135043. [PMID: 34745277 PMCID: PMC8568534 DOI: 10.1155/2021/3135043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
Background To observe the clinical effect of Pinggan Yiqi Yangshen recipe combined with labetalol hydrochloride and magnesium sulfate in the treatment of pregnancy-induced hypertension (PIH). Methods A total of 126 patients with PIH diagnosed in our hospital from January 2016 to May 2018 were randomly divided into the control group and the experimental group, with 63 cases in each group. The control group was treated with labetalol combined with magnesium sulfate. On the basis of the control group, the experimental group was treated with Pinggan Yiqi Yangshen recipe. Clinical efficacy, blood pressure, renal function, and biochemical indexes were compared between the two groups. Moreover, pregnancy outcomes and adverse reactions were compared between the two groups. Results After treatment, the total effective rate in the experimental group was higher than in the control group. Blood pressure and mean arterial pressure in the experimental group were more significantly downregulated than the control group. Renal function indexes and biochemical indexes in the experimental group were more significant than those in the control group. The incidence of cesarean section, preterm birth, and abnormal fetal heart rate in the experimental group was significantly lower than that in the control group. There was no difference in the incidence of fetal distress, postpartum hemorrhage, neonatal asphyxia, and adverse reactions between the two groups. Conclusion Pinggan Yiqi Yangshen recipe combined with labetalol hydrochloride and magnesium sulfate can effectively reduce the blood pressure of patients with PIH, help patients to return to normal levels of biochemical indexes and renal function indexes, and improve pregnancy outcomes with high safety, which is worthy of further promotion and application in clinical practice.
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8
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Bean-Thompson K, Exposito J, Fowler O, Mhaskar R, Chen L, Codolosa JN. Impact of Intravenous Antihypertensives on Outcomes Among Hospitalized Patients. Am J Hypertens 2021; 34:867-873. [PMID: 33864360 DOI: 10.1093/ajh/hpab060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many hospitalized patients with acute elevations in blood pressure (BP) are treated with intravenous (IV) antihypertensive medications without evidence of benefit. This study investigated the effects of IV as-needed (PRN) antihypertensives on BP, hospital length of stay, and mortality. METHODS We included hospitalized patients with an order for an IV PRN antihypertensive medication. We excluded patients with target organ damage. We performed multivariate analysis to assess whether the medication was independently associated with outcomes. RESULTS 1,784 out of 5,680 patients (31%) had an administration of the PRN medication. Patients who received the medication had a longer hospital stay compared with patients with an order for the medication who did not receive it (4.9 ± 6.1 vs. 3.1 ± 4.1 days, P < 0.001). This remained statistically significant after adjusting for covariates. In-hospital mortality was higher in the group that received the medication (3.3% vs. 1.6%, P < 0.001), but this was not statistically significant on multivariate analysis. IV hydralazine caused the most significant reduction in BP and led to a shorter length of stay when compared with enalapril and labetalol. A total of 62% of patients received the medication for a systolic BP lower than 180 mm Hg. CONCLUSIONS Treating hypertension in the in-patient setting remains complex. Rapid lowering of BP can cause harm to patients, and this study showed that antihypertensive medication increased hospital length of stay. Once assuring no target organ damage, a strategic approach should be to treat modifiable factors and gradually reduce BP.
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Affiliation(s)
- Kelsi Bean-Thompson
- Department of Internal Medicine, HCA Healthcare/USF Morsani College of Medicine GME: Largo Medical Center, Largo, Florida, USA
| | - Julien Exposito
- Department of Internal Medicine, HCA Healthcare/USF Morsani College of Medicine GME: Largo Medical Center, Largo, Florida, USA
| | - Oliver Fowler
- Department of Internal Medicine, HCA Healthcare/USF Morsani College of Medicine GME: Largo Medical Center, Largo, Florida, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, USF Morsani College of Medicine, Tampa, Florida, USA
| | - Liwei Chen
- Department of Medical Education, USF Morsani College of Medicine, Tampa, Florida, USA
| | - Jose Nicolas Codolosa
- Department of Internal Medicine, HCA Healthcare/USF Morsani College of Medicine GME: Largo Medical Center, Largo, Florida, USA
- Division of Cardiology, Bay Area Heart Center, St. Petersburg, Florida, USA
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9
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Mohandas R, Chamarthi G, Bozorgmehri S, Carlson J, Ozrazgat-Baslanti T, Ruchi R, Shukla A, Kazory A, Bihorac A, Canales M, Segal MS. Pro Re Nata Antihypertensive Medications and Adverse Outcomes in Hospitalized Patients: A Propensity-Matched Cohort Study. Hypertension 2021; 78:516-524. [PMID: 34148363 DOI: 10.1161/hypertensionaha.121.17279] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Rajesh Mohandas
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.).,Renal Section, North Florida/South Georgia Veterans Administration, Gainesville (R.M., A.S., M.C., M.S.S.)
| | - Gajapathiraju Chamarthi
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.)
| | - Shahab Bozorgmehri
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.)
| | - Jeremy Carlson
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.)
| | - Tezcan Ozrazgat-Baslanti
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.)
| | - Rupam Ruchi
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.)
| | - Ashutosh Shukla
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.).,Renal Section, North Florida/South Georgia Veterans Administration, Gainesville (R.M., A.S., M.C., M.S.S.)
| | - Amir Kazory
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.)
| | - Azra Bihorac
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.)
| | - Muna Canales
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.).,Renal Section, North Florida/South Georgia Veterans Administration, Gainesville (R.M., A.S., M.C., M.S.S.)
| | - Mark S Segal
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville (R.M., G.C., S.B., J.C., T.O.-B., R.R., A.S., A.K., A.B., M.C., M.S.S.).,Renal Section, North Florida/South Georgia Veterans Administration, Gainesville (R.M., A.S., M.C., M.S.S.)
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10
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El Hussein MT, Nguyen A. The Essence of Hypertensive Crises—A Mnemonic Approach. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Zhang H, Wu M, Hu Y, Li C, Zheng W, Liu J, Li X, Zhu X, Ding Y. Pharmacokinetics and pharmacodynamics of MT-1207, a novel multitarget blocker of α1 receptor, 5-HT2A receptor, and calcium channel, in healthy subjects. Expert Opin Investig Drugs 2021; 30:271-278. [PMID: 33560891 DOI: 10.1080/13543784.2021.1887137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND MT-1207 is a novel multitarget blocker of α1 receptor, 5-HT2A receptor, and calcium channel that is currently under development for the treatment of hypertension. In this study, we evaluated the tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of MT-1207 in healthy Chinese subjects. RESEARCH DESIGN AND METHODS We examined the effects of a single-ascending dose (SAD) of MT-1207 (5-40 mg) and MT-1207 (40 mg) administered in combination with food in 56 healthy subjects. RESULTS No serious adverse events or discontinuations due to adverse events (related to MT-1207) occurred in either study. MT-1207 was rapidly absorbed (median Tmax: 0.5-1.25 h). The mean t1/2 of MT-1207 was approximately 4-7 hours. Systemic exposure (Cmax and AUC) to MT-1207 increased in proportion to dose. Food had little effect on the pharmacokinetics of MT-1207, such as t1/2 and AUC. For 4h-24 h after administration, the blood pressure reduction in the MT-1207 group was higher than that in the placebo group, showing the antihypertensive effect. Blood pressure reduction after MT-1207 administration showed some dose-dependent trend in the 5-20 mg groups. CONCLUSIONS MT-1207 was well tolerated in all subjects. PD measurements demonstrated the antihypertensive effects of MT-1207.
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Affiliation(s)
- Hong Zhang
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
| | - Min Wu
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
| | - Yue Hu
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
| | - Cuiyun Li
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
| | - Wenbo Zheng
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
| | - Jingrui Liu
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
| | - Xiaojiao Li
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
| | - Xiaoxue Zhu
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
| | - Yanhua Ding
- Phase I Clinical Research Center, The First Hospital of Jilin University, Jilin, China
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Allgaier J, Emmich M, Rastegar V, Stefan MS, Lagu T. Hypertensive urgency or emergency? The use of intravenous medications in hospitalized hypertensive patients without organ dysfunction. Heart Lung 2020; 49:824-828. [PMID: 33011460 DOI: 10.1016/j.hrtlng.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/07/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Current guidelines poorly define hypertensive urgency and recommend Oral (PO) medications over intravenous (IV). OBJECTIVE To describe hospital management of hypertensive urgency and compare characteristics and outcomes of PO vs. IV medications. METHODS We used descriptive statistics and created generalized linear models to evaluate within-subject blood pressure (BP) changes over 24 hours. RESULTS 179 patients had an average age of 62 and 58% female. Chronic hypertension was common (165, 88%), as was chronic renal disease (40.6%). IV medications were common (146, 81.6%) and associated with higher comorbidity burden, prior kidney disease, and longer length of stay (2.5, 1.6-3.8 vs. 1.4, 0.9-2.2, p=0.007). 66 (35.3%) developed and 43 (23.5%) new organ dysfunction, but outcomes were similar between groups. BP was similar between groups after 12 hours. CONCLUSIONS IV medication use was common and decreased BP more rapidly. Outcomes including BP were similar to PO administration, except for length of stay.
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Affiliation(s)
- Joshua Allgaier
- Department of Medicine, University of Massachussets Medical School-Baystate, Springfield, MA, United States.
| | - Megan Emmich
- Department of Medicine, University of Massachussets Medical School-Baystate, Springfield, MA, United States
| | - Vida Rastegar
- Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Mihaela S Stefan
- Department of Medicine, University of Massachussets Medical School-Baystate, Springfield, MA, United States; Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Tara Lagu
- Department of Medicine, University of Massachussets Medical School-Baystate, Springfield, MA, United States; Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
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Anderson TS, Wray CM. Web Exclusive. Annals for Hospitalists Inpatient Notes - Inpatient Hypertension-To Treat or Tolerate? Ann Intern Med 2020; 172:HO2-HO3. [PMID: 32311720 DOI: 10.7326/m20-1021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Timothy S Anderson
- Beth Israel Deaconess Medical Center and Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts (T.S.A.)
| | - Charlie M Wray
- University of California San Francisco and San Francisco Veteran Affairs Medical Center, San Francisco, California (C.M.W.)
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