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Abstract: SA-PO504

PRN Blood Pressure Medication Use in VA Hospitals

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Rowan, Caleb J., University of Florida College of Medicine, Gainesville, Florida, United States
  • Hadley, Dexter, University of Central Florida College of Medicine, Orlando, Florida, United States
  • Yang, Seonkyeong, University of Florida College of Medicine, Gainesville, Florida, United States
  • Shorr, Ronald I., University of Florida College of Medicine, Gainesville, Florida, United States
  • Lo-Ciganic, Weihsuan, University of Florida College of Pharmacy, Gainesville, Florida, United States
  • Canales, Muna T., University of Florida College of Medicine, Gainesville, Florida, United States

Pro Re Nata blood pressure medications (PRNBP) are commonly used to treat inpatient asymptomatic hypertension. Recent studies in non-Veteran populations suggest this may increase risk of ischemic events and in-hospital mortality. To date, the extent and characteristics of PRNBP use in VA hospitals is unknown.


We obtained National VA Corporate Data Warehouse (CDW) data on medical/surgical floor hospitalizations in FY16-20 lasting ≥ 3 days for Veterans who were not on dialysis and ≥18 years old. We validated an algorithm to identify PRNBP versus no-PRNBP use in VA national data by comparing CDW data with individual chart review (30 charts per group). We applied this algorithm to report the frequency and characteristics of hospitalizations with and without PRNBP use in patients already on scheduled BP medications.


577,136 hospitalizations (381,896 unique Veterans) met our criteria at national VA hospitals. An algorithm to identify PRNBP use in VA hospitals was 97% sensitive and 100% specific. Using this algorithm, of the 577,136 hospitalizations, 142,506 (24.7%) received PRNBP defined as a one-time or PRN order. 309,126 of the 577,136 hospitalizations had scheduled BP medications (224,001 unique Veterans). We chose the first hospital stay of each unique Veteran as the unit of study (n=204,990); of these, 87,975 received at least one PRNBP during the stay and 117,015 did not. Age and BMI for those with and without PRNBP were similar (mean±SD age: 70.5±11.5 vs 70.5±11.3; BMI: 29.5±6.7 vs 30.1±6.8; standard mean difference (SMD)<0.1). Admission systolic BP was higher in the PRNBP group (mean±SD: 146.4±25.4 vs 137.0±20.8; SMD=0.4) as was mean systolic BP (138.8±17.2 vs 130.7±13.7; SMD=0.5). Stays with PRNBP had median±IQR 2.0±3.0 doses given. Hydralazine and metoprolol were the most common PRNBP (27% each). Length of stay was slightly longer for those who received PRNBP (median±IQR: 6.0±6.0 vs 5.0±4.0; SMD=0.2). Mean baseline serum creatinine was 1.3±0.9 for PRNBP vs 1.2±0.8 for those without PRNBP (SMD=0.09).


The highly sensitive and specific algorithm to identify PRNBP use in VA hospitals found that inpatient PRNBP use was very common and occurred among those with higher admission BP. This cohort is the largest to date to study PRNBP use and will be the basis of future study to examine the clinical outcomes of PRNBP use in VA hospitals.


  • Other NIH Support