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Abstract: TH-OR106

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

Session Information

Category: Hypertension and CVD

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

Authors

  • Mohandas, Rajesh, University of Florida, Gainesville, Florida, United States
  • Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States
  • Chamarthi, Gajapathiraju, University of Florida, Gainesville, Florida, United States
  • Shukla, Ashutosh M., Gainesville VA Medical Center, Gainesville, Florida, United States
  • Ruchi, Rupam, University of Florida, Gainesville, Florida, United States
  • Ozrazgat-Baslanti, Tezcan, University of Florida, Gainesville, Florida, United States
  • Kazory, Amir, University of Florida, Gainesville, Florida, United States
  • Bihorac, Azra, University of Florida, Gainesville, Florida, United States
  • Segal, Mark S., Gainesville VA Medical Center, Gainesville, Florida, United States
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.