IV antihypertensives up myocardial injury risk in hospitalized patients with severe hypertension

Use of intravenous (IV) antihypertensive treatment appears to increase the risk of myocardial injury in patients who develop severe hypertension during hospitalization and without acute target end organ damage, reveals a recent study.

Adults admitted for reasons other than hypertension who then developed severe hypertension during hospitalization, without acute target end organ damage, were included in this multihospital, retrospective study.

Severe hypertension was defined as blood pressure (BP) elevation of systolic >180 mm Hg or diastolic >110 mm Hg. Treatment was defined as receiving IV antihypertensives within 3 h of BP elevation.

The authors used overlap propensity score-weighted Cox models to assess the association between treatment and clinical outcomes during index hospitalization.

A total of 224,265 unique, nonintensive care unit hospitalizations were included in the analysis. Some 20,383 (9 percent) patients developed severe hypertension, of which 5 percent received IV antihypertensives, while 79 percent did not receive treatment within 3 h of severe BP elevation.

In the overlap propensity score-weighted population, those who were treated with IV antihypertensives had a higher risk of developing myocardial injury compared with untreated counterparts (5.9 percent vs 3.6 percent; hazard ratio [HR], 1.6, 95 percent confidence interval [CI], 1.13‒2.24).

However, such treatment was not associated with a higher risk of stroke (HR, 0.7, 95 percent CI, 0.3‒1.62), acute kidney injury (HR, 0.97, 95 percent CI, 0.81‒1.17), or death (HR, 0.86, 95 percent CI, 0.49‒1.51).

“These results suggest that IV antihypertensives should be used with caution in patients without acute target organ damage,” the authors said.