Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, PA, USA.
Department of Pharmacy, University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, PA, USA.
Int J Clin Pract. 2021 Jul;75(7):e13991. doi: 10.1111/ijcp.13991. Epub 2021 Jan 24.
Current guidelines for the management of asymptomatic hypertension (HTN) in the inpatient setting recommend the use of oral antihypertensives. However, in clinical practice, intravenous (IV) antihypertensives are commonly utilised with little supporting evidence. The objective of this study was to evaluate literature examining the safety/efficacy of IV hydralazine and labetalol in hospitalised patients with non-emergent, asymptomatic HTN.
The PRISMA guidelines were utilised to structure the systematic review. A search strategy composed of drug-, inpatient- and HTN-related terms was conducted utilising PubMed, Embase and Scopus databases through May 2020. Full-text, English-language articles describing IV labetalol and/or hydralazine use for non-emergent HTN in an inpatient setting that focused on clinical outcomes (ie vitals, adverse effects, healthcare utilisation) were included. Identified studies were screened/extracted using DistillerSR by two reviewers at each stage, and studies were evaluated qualitatively for the presence of bias.
From 3362 records identified in the search, a final set of 10 articles were identified. Four studies focused on labetalol (40%), five studies on hydralazine and labetalol (50%), and one study on hydralazine (10%). The included studies presented a variety of outcomes, but several trends were identified, including reduction in average blood pressure in eight (80%) studies, a risk of adverse effects in six (60%) and increased length of stay in one (10%).
The studies identified in this review raise concerns regarding the safety of IV hydralazine and labetalol in non-emergent HTN. Despite relatively broad clinical experience with these drugs, experimental investigations regarding their utility are recommended.
目前，针对住院无症状高血压（HTN）患者的管理指南建议使用口服降压药。然而，在临床实践中，静脉内（IV）降压药的使用较为常见，但其支持证据较少。本研究的目的是评估研究静脉注射肼屈嗪和拉贝洛尔在住院非紧急无症状 HTN 患者中的安全性/疗效。
采用 PRISMA 指南构建系统评价。通过检索 PubMed、Embase 和 Scopus 数据库，构建了包含药物、住院和 HTN 相关术语的检索策略，检索时间截至 2020 年 5 月。纳入了描述静脉注射拉贝洛尔和/或肼屈嗪用于住院非紧急 HTN 且侧重于临床结局（即生命体征、不良反应、医疗保健利用）的全文、英语文章。使用 DistillerSR 由两名评审员在每个阶段对确定的研究进行筛选/提取，并对研究的偏倚进行定性评估。
从检索中确定的 3362 条记录中，最终确定了 10 篇文章。其中 4 篇研究聚焦于拉贝洛尔（40%），5 篇研究聚焦于肼屈嗪和拉贝洛尔（50%），1 篇研究聚焦于肼屈嗪（10%）。纳入的研究提出了各种结局，但确定了几个趋势，包括 8 项研究（80%）中平均血压降低、6 项研究（60%）中不良反应风险增加以及 1 项研究（10%）中住院时间延长。
本综述中确定的研究对静脉注射肼屈嗪和拉贝洛尔治疗非紧急 HTN 的安全性提出了担忧。尽管这些药物的临床应用经验较为广泛，但建议进行关于其疗效的实验研究。
