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Safety and efficacy of intravenous hydralazine and labetalol for the treatment of asymptomatic hypertension in hospitalized patients: a systematic review
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  • Jocelyn Cawoski,
  • Katie DeBiasio,
  • Scott Donnachie,
  • Elizabeth Timanus,
  • David Zimmerman,
  • Anthony Guarascio,
  • Courtney Montepara,
  • Jordan Covvey,
  • Branden Nemecek
Jocelyn Cawoski
Duquesne University
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Katie DeBiasio
Duquesne University
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Scott Donnachie
Duquesne University
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Elizabeth Timanus
Duquesne University
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David Zimmerman
Duquesne University
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Anthony Guarascio
Duquesne University
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Courtney Montepara
Duquesne University
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Jordan Covvey
Duquesne University
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Branden Nemecek
Duquesne University
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Abstract

Background: 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 utilized with little supporting evidence. The objective of this study was to evaluate literature examining the safety/efficacy of IV hydralazine and labetalol in hospitalized patients with non-emergent, asymptomatic HTN. Methods: The PRISMA guidelines were utilized to structure the systematic review. A search strategy composed of drug-, inpatient-, and HTN-related terms was conducted utilizing 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 (i.e. vitals, adverse effects, healthcare utilization) 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. Results: 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%). Discussion: 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.

Peer review status:Published

29 Oct 2020Submitted to International Journal of Clinical Practice
30 Oct 2020Submission Checks Completed
30 Oct 2020Assigned to Editor
01 Nov 2020Reviewer(s) Assigned
21 Nov 2020Review(s) Completed, Editorial Evaluation Pending
18 Dec 20201st Revision Received
21 Dec 2020Submission Checks Completed
21 Dec 2020Assigned to Editor
21 Dec 2020Reviewer(s) Assigned
27 Dec 2020Review(s) Completed, Editorial Evaluation Pending
03 Jan 2021Editorial Decision: Accept
05 Jan 2021Published in International Journal of Clinical Practice. 10.1111/ijcp.13991