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Implementing a Policy and Protocol on Managing Patients With Hypertensive Urgencies
Christine Chim1, Erica Dimitropoulos2, Regina Ginzburg3
1St John's University College of Pharmacy and Health Sciences, Queens, NY, USA Institute for Family Health, New York, NY, USA chimc@stjohns.edu.
The Annals of Pharmacotherapy
|April 17, 2016
Summary
Short-acting clonidine for hypertensive urgency can worsen outcomes and should be avoided. A new protocol successfully reduced clonidine orders and hospital admissions, though emergency department referrals require further study.
Area of Science:
- Cardiology
- Clinical Pharmacy
- Internal Medicine
Background:
- Short-acting agents like clonidine are associated with adverse outcomes when used for hypertensive urgency in office settings.
- Current clinical practices may involve the inappropriate use of clonidine for immediate management of asymptomatic hypertension.
- Evidence suggests a need to revise protocols for hypertensive urgency to improve patient safety and outcomes.
Purpose of the Study:
- To decrease the incidence of clonidine prescriptions for immediate treatment of asymptomatic hypertension in outpatient settings.
- To evaluate the impact of a revised clinical protocol on patient outcomes following hypertensive urgency.
- To assess the safety and efficacy of avoiding short-acting antihypertensives in office-based hypertensive urgency management.
Main Methods:
- An observational cohort study was conducted to assess a protocol developed by clinical pharmacists for managing hypertensive urgencies.
- The protocol recommended avoiding short-acting antihypertensives, specifically clonidine.
- Data on clonidine orders and patient outcomes (including emergency department referrals and hospitalizations) were compared pre- and post-intervention.
Main Results:
- Clonidine orders decreased significantly from 17.4% in the preintervention cohort to 10.6% in the postintervention cohort (P = 0.001).
- While emergency department referrals increased slightly in the postintervention group, subsequent hospitalizations were eliminated compared to the preintervention group.
- No adverse effects were documented from in-office clonidine administration in either cohort.
Conclusions:
- Implementation of a hypertensive urgency protocol and targeted education effectively reduced clonidine orders and hospital admissions.
- The protocol demonstrated a positive impact on patient outcomes by decreasing the need for subsequent hospitalizations.
- Further investigation is warranted to understand the rise in emergency department referrals post-intervention.
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