As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals
Main finding · Time to first AKI occurrenceResult — go to the resultAdjusted hazard ratio 1.23 95% CI 1.18–1.29Authors' conclusion
The results of this retrospective cohort study showed that as-needed BP medication use among veterans is associated with increased AKI risk. The risks and benefits of this type of BP medication use would best be determined through a prospective trial, and these data suggest that there is the necessary equipoise to conduct such a trial.
Study context
- Population
- Adult veterans hospitalized 3 or more days in Veterans Administration hospitals between October 1, 2015, and September 30, 2020, on a non-intensive care unit medical or surgical floor, without surgery, who received at least 1 scheduled blood pressure (BP) medication in the first 24 hours of admission and had at least 1 systolic BP more than 140 mm Hg during hospitalizationveterans eligible for analysis
- Participants
- 133,760 veterans
- Exposure
- As-needed BP medication use compared to nonusers
- As-needed BP medication usersn = 28,526
- Outcome
- Time to first AKI occurrence
- Follow-up
- During hospitalization
Methodological detailstarget trial emulation, propensity score matching
- Target trial emulation
- Propensity score matching
Main finding
As reported in the abstract
Adjusted hazard ratio
1.23
95% CI 1.18–1.29
As-needed BP medication usersvs nonusers
adjusted hazard ratio 1.23 (95% CI 1.18–1.29)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Estimate |
|---|---|
| Rapid BP reduction (greater than 25% reduction in systolic BP within 3 hours)1.5-fold greater risk · secondary analysis | risk (fold greater) 1.5 (95% CI 1.39–1.62) |
| Composite of myocardial infarction, stroke, or death during hospitalization1.69-fold higher rate · secondary analysis | rate (fold higher) 1.69 (95% CI 1.49–1.92) |
Acute kidney injury (AKI) risk by route of as-needed BP medication (subgroup)
- Higher AKI risk with intravenous as-needed BP medication use (compared to oral or combined oral and intravenous routes)
Original publication
As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals. JAMA Intern Med. Published 1 January 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →