Use Of Hydralazine Research Articles

Epidemiological Profile of Neonates in Hearing Screening at a Maternity of a Tertiary Hospital in the state of Santa Catarina, Brazil.

Introduction The newborn hearing screening (NHS) test aims the early diagnostic of hearing deficits that may also harm the full development of communication and learning of the affected child. Objective Trace the clinical and epidemiological profile of children born between July 2016 and July 2019; in addition to the outcome of the NHSs and factors related to failure in the hearing tests at a maternity of a tertiary hospital in Santa Catarina, Brazil. Methods The present is a cross-sectional study. A census of those born in the period defined for study was performed and a script was developed for the review of medical records, based on the literature. Results The sample can be considered homogeneous in relation to gender and age. The pregnant women had an average of 30.9 years. There were 30 neonates (1.9%) that did not undergo NHS. New evaluations were required in 288 patients (18.2%). Finally, 24 (1.5% of the population) remained with insufficient results in the retest. The following variables achieved statistical relevance with higher failure rates in tests and/or retests: natural delivery ( p = 0.007), arterial hypertension present ( p = 0.002), use of hydralazine ( p = 0.038), and use of dipyrone in the test ( p = 0.041) and retest ( p = 0.003). Younger mothers had higher levels of normality in the test ( p = 0.003) and retest ( p = 0.161). The correlations between the other variables and the outcomes were not statistically significant. Conclusion False positives (62.8%) in the first test showed a value higher than the ideal goal; those who did not undergo the NHS (1.9%) and who needed evaluation by a specialist, due to failure in the retest (1.5%), are within the quality goals defined by the Joint Committee on Infant Hearing (JCIH) in 2007.

Comparison between adverse effects of I/v Inj Labetalol Vs Inj Hydralazine during treatment of Hypertension in pregnancy

Aim: To examine and compare side effects of intravenous Labetalol and Hydralazine in the treatment of Hypertension in pregnancy in developing countries like Pakistan. Methodology: A six-month randomised controlled experiment was undertaken at the Lady Aitchison Hospital's, Department of Obstetrics and Gynaecology. In the study, 330 individuals with severe hypertension who were between the ages of 20 and 35 years old and had been pregnant for more than 20 weeks were included. Patients were split into two groups of equal size. Group A was administered a 20mg IV bolus of Labetalol while Group B was administered a 5-10mg IV bolus of Hydralazine. The patients were monitored during the administration period of 60 minutes and all this data was entered into a proforma. Results: Females had an average age of 27.43±3.47 years and average gestational age in females was 28.98±4.49 weeks. The systolic blood pressure in all females was 109.43 ±16.93mmHg after 60 minutes of therapy, and mean diastolic blood pressure was 77.28±14.73mmHg. A total of 135(40.9%) women suffered from maternal hypotension [27(16.36%) with Labetalol vs 108(65.43%) with Hydralazine], and 55(16.68%) females exhibited abnormal fetal heart rate [1 (0.61%) with Labetalol and 54(32.72%) with Hydralazine]. Therefore, the Hydralazine adverse effect was statistically significant (p-value = 0.000). Practical Implication: If the results of this study are applied in clinical practice in patients of pregnancy induced hypertension, female patients ca be prevented of side effects of hydralazine by using labetalol to treat hypertension in pregnancy, so it is very beneficial for patients. Conclusion: The study concludes that use of Hydralazine in females with PIH should be discouraged, whereas the use of Labetalol should be encouraged in a developing country like Pakistan. Keywords: Pregnancy Induced Hypertension (PIH),Gestational Hypertension(GH), hypotension, headache, abnormal fetal heart rate, palpitation, tachycardia, intravenous.

Mechanistic Investigation of the Time-Dependent Aldehyde Oxidase Inhibitor Hydralazine.

The anti-hypertensive agent hydralazine is a time-dependent inhibitor of the cytosolic drug-metabolizing enzyme aldehyde oxidase (AO). Glutathione (GSH) was found to suppress the inhibition of AO by hydralazine in multiple enzyme sources (human liver and kidney cytosol, human liver S9, rat liver S9, and recombinant human AO) and with different AO substrates (zoniporide, O6 -benzylguanine, and dantrolene). Hydralazine-induced AO inactivation was unaffected when GSH was added to the incubation mixture after pre-incubation of hydralazine with AO (rather than during the pre-incubation), suggesting that GSH traps a hydralazine reactive intermediate prior to enzyme inactivation. Consistent with previous reports of 1-phthalazylmercapturic acid formation when hydralazine was incubated with N-acetylcysteine, we detected a metabolite producing an MS/MS spectrum consistent with a 1-phthalazyl-GSH conjugate. O6 -Benzylguanine, an AO substrate, did not protect against hydralazine-induced AO inactivation, implying that hydralazine does not compete with O6 -benzylguanine for binding to the AO active site. Catalase also failed to protect AO from hydralazine-induced inactivation, suggesting that hydrogen peroxide is not involved. However, an allosteric AO inhibitor (thioridazine) offered some protection, indicating a catalytic role for AO in the bioactivation of hydralazine. AO inhibition by phthalazine (a substrate and inhibitor of AO and a metabolite of hydralazine) was unaffected by the presence of GSH. GSH also prevented hydralazine from inhibiting the nitro-reduction of dantrolene by AO. Furthermore, the GSH-hydralazine combination stimulated dantrolene reduction. Phthalazine inhibited only oxidation reactions, not reduction of dantrolene. Together, these results support the hypothesis that hydralazine is converted to a reactive intermediate that inactivates AO. SIGNIFICANCE STATEMENT: These studies suggest that a reactive intermediate of hydralazine plays a primary role in the mechanism of aldehyde oxidase (AO) inactivation. Inactivation was attenuated by glutathione and unaffected by catalase. Phthalazine (hydralazine metabolite) inhibited AO regardless of the presence of glutathione; however, phthalazine inhibited only oxidation reactions, while hydralazine inhibited both oxidation and reduction reactions. This report advances our mechanistic understanding of hydralazine as an AO inhibitor and provides information to facilitate appropriate use of hydralazine when probing AO metabolism.

Potential Impacts of Hydralazine as a Novel Antioxidant on Cardiovascular and Renal Disease—Beyond Vasodilation and Blood Pressure Lowering

Hydralazine is a traditional antihypertensive drug that was developed several decades ago. Its most well-known effect is blood pressure lowering by arterial vasodilation. While mainly used an adjunct treatment for clinical hypertension or chronic heart failure, this old drug has also shown potential as a repurposing drug for the atherosclerosis vascular disease and various kidney diseases. Recent experimental studies suggest that hydralazine exerts antioxidative, anti-apoptotic, and HIF-1α stabilization effects for angiogenesis and vascular protection. Hydralazine also exerts reno-protective effects via its antioxidation, DNA demethylation, and anti-inflammation abilities. The above evidence provides advanced rationales for new applications of this drug beyond blood pressure lowering and arterial vasodilation. Here, we summarized the recent experimental advances in the use of hydralazine for either a vascular disease or kidney diseases, or both. Given the wide populations of people with cardiovascular and/or kidney diseases, future studies are worth validating the potential impacts of hydralazine on the clinical outcomes in selected patients.

Association between cardiovascular comorbidities and hospital admission in SARS-CoV-2 patients

Abstract Background SARS-CoV-2 infection affects the cardiovascular system and can result in vascular dysregulation and dysfunction. However, the hospitalization rates due to pre-existing cardiovascular disease and concomitant SARS-CoV-2 infection are not fully known. Purpose To further elucidate the association between hospitalization and SARS-CoV-2 patients with pre-existing cardiovascular disease. We hypothesize that pre-existing cardiovascular disease is positively associated with hospitalization in patients who test positive for SARS-CoV-2. Methods This is a retrospective study of patients 18 years and older who tested positive for SARS-CoV-2 between March 2020 and April 2021. Patients with cardiovascular co-morbidities, specifically hypertension, coronary artery disease (CAD), heart failure, were analyzed. The primary outcome was hospitalization. Secondary outcomes were all-cause mortality, myocardial infarction (MI), vasopressor use, hypotension, intubation, and acute kidney injury. Multivariate logistic regression analysis adjusted for demographics and comorbidities. Results We identified 23,076 patients who tested positive for SARS-CoV-2; the hospitalization rate was 11.8% (2,721 patients). The incidence was 722 (26.5%) for CAD, 2068 (76%) for hypertension, 534 (91.3%) for heart failure, 188 (6.9%) for ESRD, 1484 (58.6%) for diabetes in patients who were hospitalized. The adjusted odds ratio (OR) of hospitalization was of 1.54 (95% Confidence Interval [CI]: 1.112–2.125; p<0.009) in patients with CAD, 5.730 (95% CI: 4.685–7.009; p<0.001) in patients with hypertension, 3.639 (95% CI: 2.308–5.737; p<0.001) in patients with heart failure. Use of angiotensin-converting enzyme inhibitor (ACEI) (p<0.001) was associated with reduced hospitalization, while the use of hydralazine (p<0.001), beta-blockers (p<0.001), and calcium channel blockers (p<0.001) were associated with increased hospitalization. Conclusion SARS-CoV-2 positive patients with CAD, hypertension or heart failure were associated with increased hospitalization. Admitted patients were more likely to be taking calcium channel blockers, beta-blockers, and hydralazine. In contrast, these patients were also less likely to be taking ACEI. Funding Acknowledgement Type of funding sources: None.

50 Years Ago in TheJournalofPediatrics: The Search for Safe and Effective Treatment of Acute Severe Hypertension in Childhood

McLaine PN, Drummond KN. Intravenous diazoxide for severe hypertension in childhood. J Pediatr 1971;79:829-32. Children with acute presentations of severe hypertension require prompt therapy to avoid end-organ effects of uncontrolled hypertension such as hypertensive encephalopathy. Usually, an intravenous antihypertensive agent is preferred, given their more rapid onset of action compared with oral medications. No matter what agent is chosen, a major concern in treating such patients is to avoid rapid hypotension, which can lead to cerebral ischemia, especially in those with chronic hypertension. McLaine and Drummond provide one of the first descriptions of using an intravenously administered drug for children with acute severe hypertension. They gave bolus doses of diazoxide, a potassium channel activator, to 16 children aged 16 days to 16 years with severe hypertension, defined as blood pressure (BP) >140/90 mm Hg. The children all had hypertension secondary to kidney disease, and many were receiving other antihypertensive agents. Reduction of mean arterial pressure occurred within 10 minutes, with reductions of 25%-35% or more of pretreatment BP levels. Although this effect would be considered excessive according to current recommendations,1Seeman T. Hamdani G. Mitsnefes M. Hypertensive crisis in children and adolescents.Pediatr Nephrol. 2019; 34: 2523-2537Crossref PubMed Scopus (25) Google Scholar the authors reported no side effects, even though in 3 patients, the diastolic BP briefly dropped to zero! Today, intravenous diazoxide is no longer in use for the treatment of acute severe hypertension—clinicians have recognized that its use is riskier than other agents such as labetalol or hydralazine. However, even these agents have safety concerns. For example, in our analysis of the use of intravenous hydralazine in hospitalized children with acute hypertension,2Flynn J.T. Bradford M.C. Harvey E.M. Intravenous hydralazine in hospitalized children and adolescents with hypertension.J Pediatr. 2016; 168: 88-92Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar approximately 30% of doses resulted in drops of mean arterial pressure that exceeded the current recommendation of no greater than a 25% reduction.1Seeman T. Hamdani G. Mitsnefes M. Hypertensive crisis in children and adolescents.Pediatr Nephrol. 2019; 34: 2523-2537Crossref PubMed Scopus (25) Google Scholar So, the search for safe and effective treatment of acute severe hypertension in childhood continues. In the absence of prospective clinical trials in this patient population, we can at least apply the findings of pioneers like McLaine and Drummond to improve patient safety and avoid untoward outcomes.

Hydralazine augmented ultrasound hyperthermia for the treatment of hepatocellular carcinoma

This study investigates the use of hydralazine to enhance ultrasound hyperthermia for the treatment of hepatocellular carcinoma (HCC) by minimizing flow-mediated heat loss from the tumor. Murine HCC tumors were treated with a continuous mode ultrasound with or without an intravenous administration of hydralazine (5 mg/kg). Tumor blood flow and blood vessels were evaluated by contrast-enhanced ultrasound (CEUS) imaging and histology, respectively. Hydralazine markedly enhanced ultrasound hyperthermia through the disruption of tumor blood flow in HCC. Ultrasound treatment with hydralazine significantly reduced peak enhancement (PE), perfusion index (PI), and area under the curve (AUC) of the CEUS time-intensity curves by 91.9 ± 0.9%, 95.7 ± 0.7%, and 96.6 ± 0.5%, compared to 71.4 ± 1.9%, 84.7 ± 1.1%, and 85.6 ± 0.7% respectively without hydralazine. Tumor temperature measurements showed that the cumulative thermal dose delivered by ultrasound treatment with hydralazine (170.8 ± 11.8 min) was significantly higher than that without hydralazine (137.7 ± 10.7 min). Histological assessment of the ultrasound-treated tumors showed that hydralazine injection formed larger hemorrhagic pools and increased tumor vessel dilation consistent with CEUS observations illustrating the augmentation of hyperthermic effects by hydralazine. In conclusion, we demonstrated that ultrasound hyperthermia can be enhanced significantly by hydralazine in murine HCC tumors by modulating tumor blood flow. Future studies demonstrating the safety of the combined use of ultrasound and hydralazine would enable the clinical translation of the proposed technique.

Hydralazine use for the management of hypertensive crises in a medical intensive care unit

Background: Hypertensive crises, including emergent or urgent hypertension, are rare but life-threatening complications of uncontrolled hypertension. Hydralazine is one of several antihypertensive medications available for treatment of hypertensive crises. Major United States guidelines on hypertension recommend conservative use of hydralazine – only for situations of preeclampsia or eclampsia with pregnancy – due to significant adverse effects and unpredictability in the dose response.
 Methods: A retrospective chart review was conducted on patients admitted to the medical intensive care unit at University Medical Center in Lubbock, Texas, with urgent or emergent hypertension between January 1, 2017, and June 30, 2017. Demographic information - age and gender - and records of which antihypertensive medication(s) and route used were collected. Systolic blood pressure before and 2 hours after hydralazine administration - and whether it was given after an initial dose of another antihypertensive medication - was recorded. Patient comorbidities and contraindications for use were noted.
 Results: Thirty-five patients were included in this study (1 patient result was excluded from certain calculations due to missing data). Mean age of patients was 53.4 ± 12.5 years. Range was 22-74 years. Eight patients had initial treatment with hydralazine, and 29 out of 35 patients were given hydralazine when considering combination treatment. IV hydralazine was preferred over PO hydralazine (23 patients vs. 6 patients). Sixteen patients had comorbidities and/or contraindications for hydralazine use, but 12 patients received IV hydralazine and one patient received PO hydralazine.
 Conclusion: Hydralazine was not used in a guideline-directed manner in the medical intensive care unit at our hospital. Physicians should regularly evaluate patients for the presence or absence of end-organ damage concurrent with a blood pressure >180/120 mmHg before considering which
 antihypertensive medication to use. Hydralazine should be reserved for special situations involving pregnancy.
 Keywords: hydralazine, emergent hypertension, urgent hypertension, intensive medical care unit

Low-dose hydralazine during gestation reduces renal fibrosis in rodent offspring exposed to maternal high fat diet.

BackgroundMaternal high fat diet (HFD) promotes chronic kidney disease (CKD) in offspring. This is in accordance with the theory of fetal programming, which suggests adverse conditions occurring in utero predispose offspring to chronic conditions later in life. DNA methylation has been proposed as a key mechanism by which fetal programming occurs and is implicated in CKD progression. DNA demethylating drugs may interrupt the fetal programming of CKD by maternal obesity. Hydralazine, an antihypertensive agent, demethylates DNA at low doses which do not reduce blood pressure. We used a mouse model of maternal obesity to determine whether gestational administration of low-dose hydralazine to mothers can prevent CKD in offspring.MethodsC57BL/6 dams received HFD or chow from 6 weeks prior to mating and were administered subcutaneous hydralazine (5mg/kg) or saline thrice weekly during gestation. Male offspring were weaned to chow and were sacrificed at either postnatal week 9 or week 32. Biometric and metabolic parameters, renal global DNA methylation, renal structural and functional changes and markers of fibrosis, oxidative stress and inflammation were measured in offspring at weeks 9 and 32.ResultsIn week 9 offspring, maternal HFD consumption did not significantly alter anthropometric or metabolic parameters, or renal global DNA methylation. Week 32 offspring had increased renal global DNA methylation, together with albuminuria, glomerulosclerosis, renal fibrosis and oxidative stress. Administration of low-dose hydralazine to obese mothers during gestation reduced renal global DNA methylation and renal fibrotic markers in week 32 offspring.ConclusionGestational hydralazine reduced renal global DNA methylation in offspring of obese mothers and attenuated maternal obesity-induced renal fibrosis. These data support the use of low-dose hydralazine as a demethylating agent to prevent CKD arising in offspring due to maternal HFD consumption.

S2889 Pseudomelanosis Duodeni in Consecutive Endoscopies: An Indirect Marker of Long-Standing Kidney Disease?

INTRODUCTION: Much has been written about melanosis coli; in contrast, occurrences of pigmentation in the upper gastrointestinal (GI) tract remains relatively rare. Pseudomelanosis duodeni (PD) appears as a striking black-brown speckle across the mucosa, presenting a diagnostic challenge to endoscopists. The paucity of reported cases and minimal understanding makes management arbitrary. Follow-up data on the persistence of these accumulations and its long-term outcomes remain to be explored. CASE DESCRIPTION/METHODS: An 86-year-old female presented with fatigue, dizziness, and melena. She had a history of end-stage renal disease requiring hemodialysis, valvular heart disease, history of recurrent GI bleeding, anemia, and diabetes mellitus. Home medications included amlodipine, carvedilol, hydralazine, insulin (detemir and aspart), and oral iron supplements. On arrival, her vitals read BP – 156/49, HR – 78, RR – 18, Temp – 36.8°C, with an oxygen saturation of 93% on room air. The initial workup was notable for hemoglobin of 7.1 g/dL, from her baseline of 10.1 g/dL. She was transfused red cells and underwent an esophagogastroduodenoscopy (EGD), revealing multiple areas of blackish discoloration in the duodenum. Histology revealed accumulations of black pigment within macrophages in the lamina propria with villous blunting. Dialysis was resumed with darbepoetin alfa support. Once hemoglobin was stable, enteral feeding was restarted, and the patient was discharged without any medication changes with close follow-up. An extensive chart review revealed numerous EGDs in the past for similar presentations, demonstrating the gradual expansion of the speckled areas that were first noted after the initiation of dialysis four years prior. Figures 1 and 2 show the successive change. DISCUSSION: Despite being a recognized entity, much about pseudomelanosis duodeni remains unknown. In our patient, her long-standing pseudomelanosis can be attributed to chronic use of hydralazine, iron supplements, or worsening chronic renal disease requiring dialysis, all of which have been strongly implicated in the literature. This case demonstrates its ability to grow within months, and continue to persist for years, seen on serial EGDs. Altered metabolism patterns of pigments can explain its emergence after initiation of dialysis as renal function declines. Its clinical significance remains largely unknown, and no known complications or associated deaths have been reported.Figure 1.: Esophagogastroduodenoscopy (EGD) four years prior to current admission revealing an unaffected duodenal segment.Figure 2.: Esophagogastroduodenoscopy (EGD) from the most recent admission revealing black speckling consistent with pseudomelanosis duodeni.

Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position.

BackgroundHypotensive bradycardic events (HBEs) are a frequent adverse event in patients who underwent shoulder arthroscopic surgery under interscalene block (ISB) in the sitting position. This retrospective study was conducted to investigate the independent risk factors of HBEs in shoulder arthroscopic surgery under ISB in the sitting position.MethodsA total of 2549 patients who underwent shoulder arthroscopic surgery under ISB and had complete clinical data were included in the study. The 357 patients who developed HBEs were included in the HBEs group, and the remaining 2192 in the non-HBEs group. The potential risk factors for HBEs, such as age, sex, past medical history, anesthetic characteristics, and intraoperative medications were collected and compared between the groups. Statistically significant variables were included in a logistic regression model to further evaluate the independent risk factors for HBEs in shoulder arthroscopic surgery under ISB.ResultsThe incidence of HBEs was 14.0% (357/2549). Logistic regression analysis revealed that the intraoperative use of hydralazine (odds ratio [OR] 4.2; 95% confidence interval [CI] 2.9–6.3), propofol (OR 2.1; 95% CI 1.3–3.6), and dexmedetomidine (OR 3.9; 95% CI 1.9–7.8) before HBEs were independent risk factors for HBEs in patients who received shoulder arthroscopic surgery under ISB.ConclusionsThe intraoperative use of antihypertensives such as hydralazine and sedatives such as propofol or dexmedetomidine leads to increased risk of HBEs during shoulder arthroscopic surgery under ISB in the sitting position.

Heart failure treatment and the art of medical decision making.

Heart failure treatment and the art of medical decision making.

Clinical Characteristics of Hydralazine-induced Lupus.

IntroductionThe use of hydralazine has been associated with the development of lupus erythematosus and lupus-like syndromes. We performed this retrospective study to identify clinical characteristics of individuals who developed hydralazine-induced lupus.Material and methodsWe performed a single-center retrospective review of seven individuals who had a diagnosis of hydralazine-induced lupus by International Classification of Diseases, Ninth Revision (ICD9) code and were on hydralazine prior to their diagnosis. Clinical and laboratory data were obtained from a review of the medical record up to 12-month follow-up.ResultsOf the seven individuals with hydralazine-induced lupus, five were Caucasian (71%) and two were African-American. The mean age at the time of diagnosis was 62 years. Four (57%) were male.The majority of individuals were exposed to hydralazine for more than 12 months (83%). Four individuals had biopsy-proven lupus nephritis and four individuals had cardiopulmonary and skin involvement. Six patients were positive for antinuclear antibody (ANA) with a homogenous pattern, and five of those were positive for anti-histone antibody. Additionally, positive anti-double-stranded DNA (anti-dsDNA) antibody, anti-cardiolipin antibodies, low complements, positive lupus anticoagulant, and leukopenia were seen in 42% of our cohort. Of the five individuals in whom anti-myeloperoxidase (MPO) antibody was strongly positive, all had renal involvement defined by an elevated creatinine with three having biopsy-proven lupus nephritis. Three other individuals with MPO positivity had concurrent cardiopulmonary and skin involvement. Four individuals were positive for anti-proteinase 3 (PR3) antibody, three of whom were strongly positive with renal involvement defined by an elevated creatinine with two having biopsy-proven lupus nephritis. The level of anti-dsDNA antibody and anti-PR3 antibody normalized at three months while anti-MPO antibody took 12 months to normalize following cessation of hydralazine. When checked, low complement component 3 (C3) and anti-histone antibody persisted past 12 months.In addition to the withdrawal of hydralazine, six individuals were treated with hydroxychloroquine and five with mycophenolate mofetil. Three of four individuals with renal involvement received plasmapheresis and two received cyclophosphamide and hemodialysis.ConclusionHydralazine can aggravate and unmask incipient lupus. Since the presentation can be varied, early recognition of symptoms is critical. Precautions should be taken before initiating this medication in individuals with certain risk factors. Once diagnosed, potential serological findings such as a positive anti-MPO/anti-PR3 antibody could predict more severe manifestations such as pulmonary-renal complications.

Hydralazine/Isosorbide Dinitrate, Blood Pressure and Mortality in Patients with Heart Failure with Reduced Ejection Fraction

Introduction The use of hydralazine and isosorbide dinitrate (H-ISDN) has been shown to reduce mortality in African American patients with heart failure with reduced ejection fraction (HFrEF). We aimed to evaluate the association of H-ISDN use with all-cause mortality among HFrEF patients with and without hypertension in large health system serving an inner city population. Hypothesis H-ISDN is associated with lower mortality in patients with hypertension, and this association differs by race/ethnicity. Methods We queried electronic health records to identify all patients ≥18 years old diagnosed with HFrEF (EF Results Of 11,962 patients included, mean age was 65.2±15.6, mean EF 22.7±7.3%, 60% were male, 31% were non-Hispanic black, 69% were hypertensive, and 13% were prescribed H-ISDN. Overall, H-ISDN was not significantly associated with mortality among hypertensive (HR 0.88; 0.77-1.01, p=0.084), nor among normotensive patients (HR 1.12; 0.92-1.37, p=0.254). H-ISDN was associated with significant mortality reduction in hypertensive blacks (HR 0.78; 0.63-0.97, p=0.025), but not in hypertensive whites (HR 0.95; 0.69-1.32, p=0.76) or hypertensive Hispanics (HR 1.12; 0.85-1.49, p=0.422). There was no evidence of effect modification by gender in any race/ethnic group (p-interaction >0.05). H-ISDN was not significantly associated with mortality among normotensives in any race/ethnic group. Conclusion In real-world practice in a large urban center, there was a suggestion of an inverse association between H-ISDN use and mortality among hypertensive patients, but this was not statistically significant. Use of H-ISDN did show a significant association with lower mortality among hypertensive blacks, which lends support to the benefits of this drug combination in this race/ethnic group.

Retrospective review of the use of as-needed hydralazine and labetalol for the treatment of acute hypertension in hospitalized medicine patients.

The aim of this study was to evaluate the use of as-needed (PRN) labetalol and hydralazine [intravenous (IV) or oral] in hospitalized medicine patients for the treatment of severe asymptomatic hypertension and to examine the potential negative outcomes associated with their use. The electronic health record of 250 medicine patients hospitalized at the University of Colorado Hospital between November 2014 and April 2016 who received at least one dose of PRN IV or oral hydralazine or labetalol were retrospectively reviewed. The primary outcome was to describe the use of PRN antihypertensive medications in this population. A total of 573 PRN doses of antihypertensive medication were administered. Oral hydralazine was the most common (521 doses, 90.9%). A total of 36% of PRN administrations were given for a systolic blood pressure (SBP) <180 mmHg and diastolic blood pressure (DBP) <110 mmHg (cut-point for acute severe hypertension). No serious adverse events were related to PRN antihypertensive administration. Despite receiving at least one PRN antihypertensive medication during hospitalization, 40.8% of patients were not continued on their home antihypertensive medication(s) while hospitalized, and 62.4% of patients did not have their home regimens intensified at discharge. As-needed oral hydralazine is frequently prescribed for acute blood pressure lowering with administration thresholds often less than what are used to define acute severe hypertension. Many patients are prescribed PRN antihypertensive medication instead of being continued on their home regimens, and most patients do not have the intensity of their home regimens increased. Providers need to be educated about the use of PRN antihypertensive medication for the management of severe asymptomatic hypertension in the hospital setting.

PP.14.22] ON THE USE OF ISOSORBIDEDINITRATE AND HYDRALAZINE FOR HEART FAILURE IN PATIENTS OF AFRICAN ANCESTRY IN THE NETHERLANDS

Objective: The 2004 African-American Heart Failure Trial showed that fixed dose of isosorbide dinitrate plus hydralazine (Bidil) for heart failure reduced mortality with 43% and morbidity with 33% on top of standard treatment among patients of African ethnicity with NYHA class III to IV. The latest version of the Dutch Cardiology guidelines (2010) states that the drug combination could be considered in patients of African ancestry with symptomatic heart failure who do not respond to other drugs. Since we had indications for non-familiarity of prescribing doctors with the use of Bidil for heart failure, we assessed the use of this drug combination in the Netherlands.Design and method: We searched Dutch national databases for prescribed drugs. The database includes data from all Dutch health insurance companies, and could be searched for the past 12 years to a 4 digit anatomical therapeutic chemical classification system (ATC) code, C01D vasodilators used in cardiac diseases isosorbide dinitrate included, and C02D agents acting on arteriolar smooth muscle, hydralazine included. Results: The number of patients with heart failure of African ancestry living in the Netherlands, is estimated to be 2055 (621/100.000). The estimated yearly number of patients of African ethnicity in the Netherlands using any ATC C02D prescription drug was very low at 85 per year (Figure). Thus less than 5% of patients from African ancestry with heart failure could have received the combination of isosorbide dinitrate and hydralazine. Conclusions: Although the combined use of isosorbide dinitrate and hydralazine is recommended by Dutch guidelines for heart failure in African ancestry patients, we found evidence that prescription volumes are very low. Most patients do not receive this cheap and highly effective combination therapy, shown to reduce mortality in heart failure. We will transmit these findings to the relevant professional organisations.

P6172On the use of Isosorbidedinitrate and Hydralazine for heart failure in patients of African ancestry in the Netherlands

P6172On the use of Isosorbidedinitrate and Hydralazine for heart failure in patients of African ancestry in the Netherlands

Management of Severe Range Blood Pressures During Obstetrical Care: A Quality Improvement Project [3L

INTRODUCTION: Hypertensive disorders of pregnancy are a leading cause of maternal and neonatal morbidity and mortality. Timeliness of treatment improves maternal and neonatal outcomes. This study assesses the impact of implementing a program for severe range blood pressure (SRBP) management during inpatient obstetrical care. METHODS: We prospectively collected data from a single academic center during 2015-2016 comparing outcomes before and after a system change. The changes included 1) an algorithm to improve blood pressure (BP) recheck times (for validating SRBP) and time to intravenous medication when indicated; 2) improved medication access making all medications equally available; and 3) multidisciplinary training including simulation sessions. All patients with ICD-10 codes of pregnancy-related hypertensive disorders who had SRBP were evaluated over a three-month period before and after program implementation. SRBP treatment included intravenous labetalol or hydralazine or oral nifedipine. Primary endpoints compared time to BP recheck, time to medication when indicated and type of medication. RESULTS: More women had a BP recheck within one hour post-implementation (330/344, 95.9%) vs. pre-implementation (390/425, 91.7%) (P=.0025). A similar improvement occurred when evaluating BP recheck within 10 minutes (60.5% vs. 40.0%, respectively, P=.0001). For the 113 post-implementation and 89 pre-implementation SRBP events requiring treatment, time to medication did not improve (median 13 and 14 minutes, respectively, P=.40). Use of labetalol vs. hydralazine post-implementation increased from 13.3% to 38.1% (P=.0001); nifedipine was rarely used (1 and 3 patients, respectively). CONCLUSION: Implementation of an algorithm to treat SRBP can improve BP recheck rates and impact choice of intravenous medications.

ADVERSE OUTCOMES WITH USE OF HYDRALAZINE AND NITRATE COMBINATION THERAPY IN HOSPITALIZED OLDER NON-BLACK PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION (HFREF)

Background: A combination of hydralazine and isosorbide dinitrate is recommended to self-described African American patients with HFrEF receiving optimal therapy with ACE inhibitors and beta-blockers, unless contraindicated. We examined the association of the use of both hydralazine and nitrates

Risks of parenteral antihypertensive therapy for the treatment of severe maternal hypertension are low

ABSTRACTObjective: To determine whether the incidence of hypotension or adverse fetal heart tracing (FHT) category change differed following antepartum administration of intravenous (IV) labetalol versus hydralazine. Methods: Blood pressure and FHT categories were assessed one hour before and after medication administration. Hypotension was defined as ≥30% reduction in baseline systolic blood pressure (SBP) or SBP <90 mmHg. Changes in mean arterial pressure (MAP) were also compared. The National Institute for Child Health and Human Development (NICHD) three-tier category system was used to describe the FHT. For all category II tracings, Parer and Ikeda’s system was also used. Results: Sixty-nine women received hydralazine and 31 women received labetalol during the study period. The incidence of hypotension (≥30% reduction in SBP) was similar between the labetalol (10%) and hydralazine (11%) groups (p = 0.98). No women experienced post-treatment SBP <90 mmHg. No association was observed between fetal heart rate category change and drug used. No women required emergent delivery for fetal indications. Conclusions: The incidence of maternal hypotension was low and did not differ following antepartum IV labetalol versus hydralazine use. These data should reassure providers about the use of parenteral labetalol and hydralazine for the treatment of severe hypertension.