Work

Reducing the Nonindicated Use of IV Hydralazine in the Inpatient Setting

Year: 2025

Type: article

Abstract: BACKGROUND: 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. PROJECT RATIONALE: At UConn John Dempsey Hospital, 69% of IV hydralazine use between June 2023 and January 2024 lacked appropriate indications. PROJECT SUMMARY: 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. TAKE-HOME MESSAGES: 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.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105712

Authors: Ashwin Kumar, John Lynch, Jennifer Baldwin

Institution: UConn Health

Language: English

Topic: Blood Pressure and Hypertension Studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850