Kidney Week

Abstract: TH-OR106

PRN Use of Antihypertensive Medications and Adverse Renal Outcomes: A Propensity Score-Matched Analysis

Session Information

• Hypertension and CVD: Therapies and Predictors
  November 07, 2019 | Location: 206, Walter E. Washington Convention Center
  Abstract Time: 06:06 PM - 06:18 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Mohandas, Rajesh, University of Florida, Gainesville, Florida, United States

Rajesh Mohandas, MD, MPH, FASN



Dr. Rajesh Mohandas MD, MPH, FASN is an Associate Professor of Medicine and Physiology at the University of Florida. His clinical focus is on hypertension and he directs the Hypertension Clinic for the Division of Nephrology. His NIH and VA funded research focuses on the vascular complications of kidney disease, particularly the molecular mechanisms and consequences of vascular stiffness.

• Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States

Shahab Bozorgmehri,

• Chamarthi, Gajapathiraju, University of Florida, Gainesville, Florida, United States

Gajapathiraju Chamarthi,

• Shukla, Ashutosh M., Gainesville VA Medical Center, Gainesville, Florida, United States

Ashutosh M. Shukla,

• Ruchi, Rupam, University of Florida, Gainesville, Florida, United States

Rupam Ruchi,

• Ozrazgat-Baslanti, Tezcan, University of Florida, Gainesville, Florida, United States

Tezcan Ozrazgat-Baslanti,

• Kazory, Amir, University of Florida, Gainesville, Florida, United States

Amir Kazory,

• Bihorac, Azra, University of Florida, Gainesville, Florida, United States

Azra Bihorac,

• Segal, Mark S., Gainesville VA Medical Center, Gainesville, Florida, United States

Mark S. Segal,

Background

Despite absence of data demonstrating a clear benefit, hospitalized patients are often treated with PRN antihypertensive medications (PRNBPMeds) for asymptomatic increases in blood pressure. We hypothesized that use of PRNBPMeds can be associated with abrupt lowering of blood pressures (BP) and worsening renal function.

Methods

Single center retrospective study of all adult patients admitted between Jan 2012 and April 2016 who received antihypertensive medications. We excluded those with possible hypertensive emergency, end stage renal disease and acute kidney injury (AKI) on admission. Patients who received PRN and scheduled antihypertensive medications were matched (1:1) by propensity scores which included systolic blood pressure on admission, demographic factors and comorbidities. Outcomes of interest were abrupt decrease in blood pressure, defined as >25% decrease in systolic blood pressures (SBP) within one hour of administration of PRN or scheduled medications and AKI.

Results

Mean age was 62±16 years. 52% were females, and 68% Caucasian. 82% of patients had hypertension. PRNBPMeds were used in 4,850 (13%) out of a total of 37,145 admissions. 93% of these patients had scheduled and PRN medications while 7% received PRNBPMeds alone. The propensity score-matched cohort included 3,707 patients each in the PRNBPMeds and scheduled antihypertensive groups.The abrupt decrease in SBP rates were 11.6% and 3.5% for PRN and scheduled medications groups, respectively, (p<0.001). The AKI occurrence rates were 14.7% and 11.6% for PRN and scheduled medications groups, respectively, (p<0.001). Using the propensity score-matched analysis, the use of PRN medications was associated with 138% increased risk of abrupt decrease in SBP (OR, 2.38 [95%CI, 1.74-3.26]; p<0.001), and 29% increased risk of AKI (OR, 1.29 [95%CI, 1.13-1.47]; p<0.001).

Conclusion

To our knowledge, this is the first propensity-scored matched analysis of PRN vs scheduled antihypertensive medications. Our results suggest that use of PRNBPMeds is associated with increased risk of abrupt BP lowering and AKI. Pragmatic randomized controlled trials are required to assess the risk benefit of treating asymptomatic increases in BP in hospitalized patients.