Assess Before Rx: The Harmful Over-Treatment of Asymptomatic Hypertension

Sara Diana Pasik

Icahn School of Medicine at Mount Sinai

Sara Diana Pasik is an MD candidate at the Icahn School of Medicine at Mount Sinai. She received her BA from Barnard College in 2014 where she majored in Neuroscience. Before matriculating at Sinai, she worked for NewYork-Presbyterian Hospital in the department of Strategy as an Associate Planner. While at NYP, she developed her interest in high value care and identification of the drivers of overuse. She joined the student High Value Care committee as a co-chair and project lead at the start of her medical education in the fall of 2016. Since then, she has been associated with the Lown Institute and is a member of the Right Care Alliance. She is also a student leader for Sinai’s chapter of Medical Students For Choice and a co-chair of their Interventional Radiology Interest Group. She is currently conducting surgical outcome research in the fields of Urology and Orthopedics, as well as high-value care research related to the overuse of IV anti-hypertensive medications.

Jeong Yun (John) Yang

Icahn School of Medicine at Mount Sinai

Jeong Yun (John) Yang is an M.D. candidate at the Icahn School of Medicine at Mount Sinai. He received his bachelor degrees in Biology and in Latina and Latino Studies and graduated with honors from Northwestern University. His work focuses on reducing the unnecessary use of intravenous anti-hypertensive drugs in an in-patient setting. He is the Director of REMEDY (Recovered Medical Equipment for the Developing World) at the Mount Sinai Hospital, a 501(c)(3) nonprofit organization dedicated to recover unused medical supplies for global aid, waste reduction, and cost-effectiveness. He is also a strong advocate for increasing cancer awareness and the importance of collaboration among medical professionals, researchers, legislators, and community groups. He conducts basic science, translational, and clinical research for cancer drug development and epidemiology. He plans to continue quality improvement, global aid, advocacy, and research throughout his medical career.

Abstract

Introduction: One third of Americans suffer from hypertension; however, only 1-2% have hypertensive emergency. Well-established guidelines outline how to treat this ailment through the use of intravenous (IV) anti-hypertensive... [ view full abstract ]

Introduction: One third of Americans suffer from hypertension; however, only 1-2% have hypertensive emergency. Well-established guidelines outline how to treat this ailment through the use of intravenous (IV) anti-hypertensive medications. Alternatively, hypertensive urgency lacks guidelines in inpatient treatment, resulting in frequent treatment with IV anti-hypertensives. This aggressive treatment is costly and can result in harm to patients.

Methods: We performed a retrospective review of one-time orders of anti-hypertensives from January-July 2016 on medicine units at a large institution in New York to conduct a cost-analysis. Additionally, we assessed current attitudes and practice of nurses, nurse practitioners, and house-staff on treatment of asymptomatic hypertension through an anonymous, electronic survey.

Results: There were 572 one-time orders of labetalol and hydralazine on two units over a 7-month period. Incorporating nurse time, we calculated the estimated annual cost at our institution to be over $130,000. Survey results revealed that 64% of nurses believe it is dangerous not to treat elevated blood pressure (>170 systolic) (n=11); 40% of NPs treat at a threshold lower then the definition of hypertensive urgency (n=10); and 82% of house-staff do not regularly assess patients with high blood pressure despite 100% of subjects knowing about side effects of the medications and 100% identifying other causes for elevated blood pressure (n=27).

Conclusion/Discussion: Over-treatment of asymptomatic hypertension is prevalent and expensive. Our review shows this overuse of treatment in our medical units, with a cost analysis. Our survey data demonstrate that the majority of care team members believe in this treatment despite known adverse events. A consideration of other etiologies and assessing for symptoms is necessary when patients have elevated blood pressure (“Assess before Rx”). Implementation of an interdisciplinary approach is needed to reduce overuse of unnecessary and harmful anti-hypertensives.

Authors

Sara Diana Pasik (Icahn School of Medicine at Mount Sinai)
Sophia Chiu (Icahn School of Medicine at Mount Sinai)
Catherine Sinfield (Icahn School of Medicine at Mount Sinai)
Jeong Yun (John) Yang (Icahn School of Medicine at Mount Sinai)
Aakash Keswani (Icahn School of Medicine at Mount Sinai)
SriLekha Tummalapalli (Mount Sinai Hospital)
Hyung Cho (Mount Sinai Hospital)
Mona Krouss (Mount Sinai Hospital)

Topic Areas

Prevalence and drivers of overuse , Harms of overuse (physical, psychological or system-related) , Oversupply of providers (e.g. hospitals, physicians, etc) and technologies (e.g. imaging, , Organizational factors (such as structure and culture) that drive overuse

Session

AS-1A » Abstract Slams: Drivers of Overuse (12:00 - Friday, 5th May, Salons 1, 2, & 3)

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