Pro Re Nata Antihypertensive Medications and Adverse Outcomes in Hospitalized Patients: A Propensity-Matched Cohort Study.
Pro Re Nata Antihypertensive Medications and Adverse Outcomes in Hospitalized Patients: A Propensity-Matched Cohort Study.
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DOI：
10.1161/hypertensionaha.121.17279
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Segal MS
中科院分区：
文献类型：
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作者：
Mohandas R;Chamarthi G;Bozorgmehri S;Carlson J;Ozrazgat-Baslanti T;Ruchi R;Shukla A;Kazory A;Bihorac A;Canales M;Segal MS
医生通常在“按需”或按需（PRN）订购血压药物，以控制住院患者的血压。我们假设，对于没有高血压急症的住院患者，根据需要使用降压药物治疗可能会导致不良结局。4，219例除预定降压药物外还按需接受降压药物治疗的患者与仅接受预定降压药物治疗的患者进行了1：1的倾向匹配。与倾向匹配队列相比，按需接受抗高血压药物治疗的患者更可能发生收缩压突然降低急性肾损伤（OR，1.24 [95%CI，1.09-1.42]，p= 0.002）和缺血性卒中（OR，2.05 [95%CI，1.56 -2.71]，p <0.001（OR，8.5 [95%CI，1.96 -36.79]; p<0.001）。按需使用抗高血压药物也与住院死亡率增加（OR，2.36 [95% CI，1.26-4.41]; p=0.001）和中位住院时间增加相关[4.7天vs. 2.9天; p<0.001]。此外，缺血性事件更可能发生在那些血压突然下降的人中，并且风险与所需血压药物给药的剂量成比例增加。按需使用抗高血压药物与血压突然下降、缺血性事件风险增加、住院死亡率和住院时间延长相关。我们建议不鼓励按需常规使用抗高血压药物。
Physicians routinely order blood pressure medications on an ‘as needed basis’ or pro re nata (PRN) to control blood pressures in hospitalized patients. We hypothesized that treatment of inpatients, who do not have a hypertensive emergency, with the use of antihypertensive medication on an as needed basis could lead to adverse outcomes. 4,219 patients who received blood pressure medications on an as needed basis in addition to scheduled antihypertensive medications, were matched 1:1 using propensity matching to those who received only scheduled blood pressure medications. Compared to the propensity matched cohort, patients who received antihypertensive medications on an as needed basis were more likely to experience abrupt lowering of systolic blood pressures (OR, 2.05 [95% CI,1.56–2.71] p <0.001], acute kidney injury (OR, 1.24 [95% CI, 1.09–1.42], p=0.002), and ischemic stroke (OR, 8.5 [95% CI,1.96–36.79]; p<0.001). The use of as needed antihypertensive medication was also associated with increased in-hospital mortality (OR, 2.36 [95% CI, 1.26–4.41]; p=0.001) and an increase in the median length of stay [4.7 days vs. 2.9 days; p<0.001]. In addition, ischemic events were more likely in those who had an abrupt drop in blood pressures and the risk was increased in proportion to the number of doses of as needed blood pressure medications administered. The use of as needed antihypertensive medication is associated with an abrupt drop in blood pressures, increased risk of ischemic events, in-hospital mortality, and longer length of stay. We suggest that the routine use of as needed antihypertensive medication should be discouraged.