Provider Knowledge and Practices Regarding Inpatient Hypertension Management

1Medical University of South Carolina, Charleston, SC
2University of Michigan, Ann Arbor, Ml
3Medical University of South Carolina, Charleston, SC

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 8

Background:

Hypertension (HTN) is a highly prevalent cardiovascular risk factor affecting more than 65 million Americans. Studies suggest that HTN is particularly prevalent among inpatient populations. Little is known about provider knowledge and practices regarding the management of elevated BP among inpatients, and current guidelines do not specifically address inpatient BP treatment. We conducted a survey of internal medicine (IM) residents to better understand trainee knowledge and practices regarding inpatient hypertension.

Methods:

After obtaining IRB approval, IM trainees were invited to complete a 16‐item survey. Additional e‐mail reminders with a Web link to an electronic version of the survey were also sent. Descriptive statistics were performed using SAS statistical software (Version 9.2, Cary, NC).

Results:

Forty‐seven completed surveys were collected (49% response rate). Respondents were distributed evenly by year of postgraduate training, were 66% male, and had a median of 7–8 months of inpatient experience in the past year. Ninety‐one percent rated inpatient BP control at 4 or 5 on a 5‐point Likert scale (5 = Very Important). Seventy‐two percent of trainees reported following Joint National Committee 7 (JNC‐7) guidelines for BP management, and 93% considered medical comorbidities when titrating BP medications. Mean BP that would spur a medication change was 151/93 (SD 9.5/6.4). Sixty‐eight percent estimated that they adjusted BP medications in at least 50% of hypertensive inpatients. Mean BP that would spur a delay in discharge was 168/97 (SD 33/20). For oral treatment of elevated BP, trainees favored ACE inhibitor/angiotensin receptor blockers (77%), beta‐blockers (BBs; 74%), hydralazine (53%), calcium channel blockers (CCBs; 51%), and diuretics (53%). For IV treatment of elevated BP, trainees favored hydralazine (81 %), BBs (51 %), and CCBs (15%). In case vignettes, 42% would treat an isolated, asymptomatic elevated BP measure with IV or PO medications, and 58% would not.

Conclusions:

Internal medicine trainees appeared to consider inpatient BP control a high priority and reported being fairly aggressive in titrating medication regimens. A majority reported following JNC‐7 guidelines, but they also reported tolerating a higher than recommended BP before making medication changes. This may result from uncertainty regarding the diagnosis of HTN among inpatients or confusion regarding how to apply guidelines to this special population. Favored oral BP agents for inpatients were similar to those used in the outpatient setting, but surprisingly, hydralazine was used with high frequency for acutely elevated BP over other agents. Reasons for this are unclear, but further study will be necessary to determine if this is an institution‐specific preference or if it is a more widely held preference. In case vignettes, trainees had divergent approaches to acutely elevated, asymptomatic BP.

Author Disclosure:

R. Axon, none; A. Weder, none; B. Egan, none.

To cite this abstract:

Axon R, Weder A, Egan B. Provider Knowledge and Practices Regarding Inpatient Hypertension Management. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 8. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/provider-knowledge-and-practices-regarding-inpatient-hypertension-management/. Accessed July 16, 2019.

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