951: Delays in administration of antihypertensive medication for hypertensive emergencies at a tertiary care center

Abstract

Sustained severe-range blood pressure (SRBP) in pregnancy (≥160 mmHg systolic or 110 mmHg diastolic for ≥15 minutes) can lead to significant morbidity and mortality1–3. The National Partnership for Maternal Safety recommends treatment of SRBP within 30–60 minutes4. A review of >3.3 million births found that only 48% of women who died received antihypertensive medication (AHM) prior to a cerebrovascular accident5. We sought to quantify the frequency of delays in administration of AHM for SRBP. In this retrospective cohort study, we included all patients admitted to a tertiary labor and delivery unit from 11/1/2018-1/31/2019 with SRBP. Patients were excluded if they received nifedipine for preterm labor. We report clinical characteristics and outcome variables using descriptive statistics and linear regression. Seventy-one women with SRBP received 102 rapid acting AHM doses. Patients were aged 21-48 and identified as 35% White, 30% Black, and 21% Hispanic. Median gestational age (GA) was 33 weeks 1 day. SRBPs ranged from 160-230 mmHg systolic and 77-123 mmHg diastolic. The median time to receive the first AHM was 45.5 minutes (0-232 minutes). AHM treatment was within 30 minutes in 28.1%, within 60 minutes in 59.2% and >60 minutes in 40.8%. The median duration of SRBP was 77 minutes (18-450 minutes). The median time for the provider to order AHM was 42.9 minutes (0-194 minutes), for pharmacy approval was 7 minutes (0-23 minutes), and for administration by the nurse was 3 min (0-20 minutes). There was no correlation between time to treatment and severity of SRBP, GA, race, or time of day. The AHM used were labetalol (46.1%), hydralazine (35.5%) and nifedipine IR (18.4%). The median time to up-titration was 42 minutes (15-100 minutes). Despite national guidelines, many patients did not receive recommended AHM therapy and had SRBP for extended periods of time. Hospitals should evaluate their AHM timing, as frequency and etiology of delays are not always recognized. Protocols to facilitate timely treatment of patients with SRBPs are warranted.