QI initiative can decrease unnecessary IV treatment of asymptomatic hypertension


Background: Limited research suggests IV treatment of asymptomatic hypertension may be widespread and unhelpful. There is potential for unnecessary treatment to have adverse outcomes, such as hypotension.

Dr. Poonam Sharma of Duke University Health System, Durham, N.C.

Dr. Poonam Sharma

Study design: Retrospective cohort study.

Setting: A single academic hospital.

Synopsis: Of 2,306 inpatients with asymptomatic hypertension, 11% were treated with IV medications to lower their blood pressure. Patients with indications for stricter blood pressure control (such as stroke, intracranial hemorrhage, aortic dissection) were excluded from the study. Following the baseline period, an education intervention was employed that included presentations, handouts, and posters. A second phase of quality improvement intervention included adjustment of the electronic medical record blood pressure alert parameters from more than 160/90 to more than 180/90. After these interventions, a lower percentage of patients received IV blood pressure medications for asymptomatic hypertension without a significant change in the number of rapid response calls, ICU transfers, or code blues. Limitations include that this is a single-center study and it is unclear if the performance improvement seen will be maintained over time.

Bottom line: IV antihypertensive use for asymptomatic hypertension is common despite lack of data to support its use, and reduced use is possible using quality improvement interventions.

Citation: Jacobs Z et al. Reducing unnecessary treatment of asymptomatic elevated blood pressure with intravenous medications on the general internal medicine wards: a quality improvement initiative. J Hosp Med. 2019 Mar;14(3):144-50.

Dr. Sharma is associate medical director for clinical education in hospital medicine at Duke Regional Hospital and an assistant professor of medicine at Duke University.

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