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ACEP 13: IV Antihypertensive Therapies for High BP in the ED

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The Particulars: Few studies have looked at the appropriateness of intravenous (IV) antihypertensive medication use in ED patients with elevated blood pressure (BP).

Data Breakdown: For a study involving patients administered at least one dose of an IV antihypertensive medication, researchers deemed that the therapy was inappropriate in 32.0% of cases. In the appropriate therapy group, 60.0% were evaluated for a hypertensive emergency, 35.5% were diagnosed with a hypertensive emergency, and 5.0% were given IV therapy after a trial of oral therapy. In the inappropriate therapy group, 47.0% were given IV boluses for elevated BP in the absence of signs of symptoms of end-organ damage. Also, 38% of this group did not receive further evaluation upon ED discharge and 14.7% had no hypertension-related diagnosis.

Take Home Pearls: Nearly one-third of ED patients who receive at least one dose of IV antihypertensive medication appear to receive such therapy inappropriately. In addition to not benefiting patients, this can potentially increase costs and may contribute to drug shortages.

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