Dosing trajectories of antihypertensive agents among preterm neonates: A retrospective, cross-sectional analysis

Preterm infants are at increased risk for hypertension due to incomplete organ development. With no established guidelines for treating hypertension in this population, clinicians rely on their experience, and little is known regarding those treatment decisions. This study described dosing trajectories for the three most common antihypertensive agents in preterm infants.

This retrospective, cross-sectional study examined preterm neonates (gestational age at birth < 37 weeks, postmenstrual age < 44 weeks) treated with antihypertensive medications at the University of Alabama at Birmingham (UAB) Medical Center. The study identified the three most common antihypertensive agents and identified common dosing patterns over time using the functional K-means algorithm. We then compared demographic and clinical information across these clusters.

The study included 87 patients across 93 visits. The three most common antihypertensive agents were propranolol (61%), captopril (8.8%), and esmolol (12%). Median treatment durations were 292 hours for propranolol, 186 hours for captopril, and 68 hours for esmolol. Propranolol was often initiated at a dose that was maintained with few dosing changes. Patients needing higher doses of propranolol were generally younger gestational age and spent longer in the hospital. Captopril doses started low and increased over time, likely due to safety concerns. Esmolol showed the most variable dosing trajectories.

Propranolol is often initiated at a target dose and maintained with less titration, while both captopril and esmolol are titrated more often. Younger gestational age patients typically required higher doses of propranolol.