Written by Amanda Mathews
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Patients who received as-needed antihypertensive medications while hospitalized had higher risk for acute kidney injury (AKI).
Hypertension is just a number, right?
This retrospective study compared veterans across multiple VA hospitals from 2016-2022 who were admitted to a medical or surgical floor for three days or longer. ICU patients were excluded. 133,760 unique patients were found and divided into two cohorts: 1) received at least one dose of as-needed blood pressure medication (28,526) and 2) received only scheduled BP medications (105,234).
Primary outcome was time to the first AKI event during hospitalization. Time started after administration of the first PRN BP dose for the first cohort and at the time of the first scheduled BP medication in the second cohort. After propensity score matching, AKI was 23% more likely to occur among veterans who received one PRN BP medication. AKI was more pronounced in certain subgroups, such as those who received an IV PRN medication (64%). There were a number of limitations to this study including its retrospective nature, lack of generalizability, with 96% of patients being male, and difficulty fully assessing whether patients who received PRN medications were asymptomatic or something else was being treated.
How will this change my practice?
While this study is not practice-changing in emergency medicine, it does put data to something we know is true: Treating a number and not a patient is bad medicine. I do not treat hypertension in the ED without a clinical indication, and I know very few of my colleagues who do. ACEP has a clinical policy on asymptomatic hypertension that is worth referencing for all practicing EM providers and supports foregoing testing and treating patients who are asymptomatic.
Source
As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals. JAMA Intern Med. 2025 Jan 1;185(1):52-60. doi: 10.1001/jamainternmed.2024.6213. PMID: 39585709
