Study discourages use of as-needed antihypertensives in hospitalized patients

Using as-needed blood pressure (BP)-lowering medication in hospitalized patients may do more harm than good, contributing to an abrupt drop in BP levels and heightened risks of ischaemic events, in-hospital mortality, and longer length of stay, according to a study.

The analysis included 4,219 patients who were given antihypertensive medications on an as-needed basis, along with scheduled BP-lowering medications. They were matched 1:1 using propensity score to those who received only scheduled BP medications (control).

Compared with controls, patients who received BP-lowering medications on an as-needed basis tended to experience abrupt drops in systolic BP (odds ratio [OR], 2.05, 95 percent confidence interval [CI], 1.56–2.71; p<0.001), acute kidney injury (OR, 1.24, 95 percent CI, 1.09–1.42; p=0.002), and ischaemic stroke (OR, 8.5, 95 percent CI, 1.96–36.79; p<0.001).

The use of as-needed antihypertensive medication also conferred a risk increase in in-hospital mortality (OR, 2.36, 95 percent CI, 1.26–4.41; p=0.001) and correlated with a higher median length of stay (4.7 vs 2.9 days; p<0.001).

Patients who experienced an abrupt drop in BP were likely to experience ischaemic events, with the risk rising in proportion to the number of doses of as-needed BP-lowering medications administered.

The present data demonstrate that administering as-needed antihypertensive medications should be discouraged.