Reducing the Nonindicated Use of IV Hydralazine in the Inpatient Setting

Elevated blood pressure (BP) affects up to 72% of hospitalized patients. Intravenous (IV) antihypertensives are indicated for hypertensive emergencies, but they are often given for asymptomatic BP elevations, leading to hypotension, acute kidney injury, and intensive care unit transfers without improving outcomes.

At UConn John Dempsey Hospital, 69% of IV hydralazine use between June 2023 and January 2024 lacked appropriate indications.

A redesigned order set required prescribers to select a guideline-supported indication before ordering hydralazine. The order also displayed the last 5 BPs and included hyperlinks to American Heart Association guidelines. Education sessions for residents and nurses reinforced best practices and provided alternatives for asymptomatic BP elevations.

Nonindicated IV hydralazine use decreased from 69% to 25%. Order set modifications had a greater impact than education alone. Embedding decision support with targeted education offers a scalable, reproducible model for safer inpatient prescribing.