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{
    "pk": 10514,
    "title": "Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department",
    "subtitle": null,
    "abstract": "Introduction:\n While moderate to severely elevated blood pressure (BP) is present in nearly halfof all emergency department (ED) patients, the incidence of true hypertensive emergencies inED patients is low. Administration of bolus intravenous (IV) antihypertensive treatment to lowerBP in patients without a true hypertensive emergency is a wasteful practice that is discouragedby hypertension experts; however, anecdotal evidence suggests this occurs with relatively highfrequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensivetreatment in ED patients with elevated BP absent a hypertensive emergency.\nMethods:\n We performed a retrospective cohort study from a single, urban, teaching hospital.Using pharmacy records, we identified patients age 18-89 who rec eived IV antihypertensivetreatment in the ED. We defined treatment as inappropriate if documented suspicion for anindicated cardiovascular condition or acute end-organ injury was lacking. Data abstractionincluded adverse events and 30-day readmission rates, and analysis was primarily descriptive.\nResults:\n We included a total of 357 patients over an 18-month period. The mean age was 55;51% were male and 93% black, and 127 (36.4%) were considered inappropriately treated.Overall, labetalol (61%) was the most commonly used medication, followed by enalaprilat(18%), hydralazine (18%), and metoprolol (3%). There were no significant differences betweenappropriate and inappropriate BP treatment groups in terms of clinical characteristics oradverse events. Hypotension or bradycardia occurred in three (2%) patients in the inappropriatetreatment cohort and in two (1%) patients in the appropriately treated cohort. Survival todischarge and 30-day ED revisit rates were equivalent.\nConclusion:\n More than one in three patients who were given IV bolus antihypertensive treatmentin the ED received such therapy inappropriately by our definitio n, suggesting that significantresources could perhaps be saved through education of providers and development of clearlydefined BP treatment protocols. [West J Emerg Med. 2017;18(5)957-962.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "hypertension"
        },
        {
            "word": "hypertensive emergency, antihypertensive therapy"
        }
    ],
    "section": "Critical Care",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/7k58685w",
    "frozenauthors": [
        {
            "first_name": "Joseph",
            "middle_name": "B.",
            "last_name": "Miller",
            "name_suffix": "",
            "institution": "Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan",
            "department": "None"
        },
        {
            "first_name": "Andrew",
            "middle_name": "",
            "last_name": "Arter",
            "name_suffix": "",
            "institution": "Detroit Medical Center, Detroit Receiving Hospital, Detroit, Michigan",
            "department": "None"
        },
        {
            "first_name": "Suprat",
            "middle_name": "S.",
            "last_name": "Wilson",
            "name_suffix": "",
            "institution": "Detroit Medical Center, Detroit Receiving Hospital, Detroit, Michigan",
            "department": "None"
        },
        {
            "first_name": "Alexander",
            "middle_name": "T.",
            "last_name": "Janke",
            "name_suffix": "",
            "institution": "Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Aaron",
            "middle_name": "",
            "last_name": "Brody",
            "name_suffix": "",
            "institution": "Wayne State University, Department of Emergency Medicine, Detroit, Michigan",
            "department": "None"
        },
        {
            "first_name": "Brian",
            "middle_name": "P.",
            "last_name": "Reed",
            "name_suffix": "",
            "institution": "Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut\nWayne State University, Department of Emergency Medicine, Detroit, Michigan",
            "department": "None"
        },
        {
            "first_name": "Phillip",
            "middle_name": "D.",
            "last_name": "Levy",
            "name_suffix": "",
            "institution": "Wayne State University, Department of Emergency Medicine, Detroit, Michigan\nWayne State University, Cardiovascular Research Institute, Detroit, Michigan",
            "department": "None"
        }
    ],
    "date_submitted": "2016-12-21T04:35:56Z",
    "date_accepted": "2016-12-21T04:35:56Z",
    "date_published": "2017-07-11T14:51:58Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/10514/galley/5781/download/"
        }
    ]
}