Implementing a Policy and Protocol on Managing Patients With Hypertensive Urgencies

Background: The use of short-acting agents, such as clonidine, for hypertensive urgency has been shown to worsen outcomes and, therefore, should be avoided in the office. Objectives: The primary objective was to achieve decreased rates of clonidine orders for immediate treatment of asymptomatic hypertension in the office. The secondary objective was to determine if reduced use leads to a decline in poor outcomes. Methods: This was an observational cohort study evaluating a protocol and algorithm developed by clinical pharmacists on the appropriate management of hypertensive urgencies. The protocol included the provision of avoiding short-acting antihypertensives (ie, clonidine). Preintervention and postintervention reports were generated to determine the number of times clonidine was ordered in the office. Electronic health charts were also reviewed for documentation of poor outcomes related to clonidine administration within 1 week of the hypertensive urgency visit date. Results: In the preintervention cohort, 106 (17.4%) orders of clonidine were captured compared with 73 (10.6%) in the postintervention group (P = 0.001). Of the patients who were administered clonidine, 7 patients in the preintervention group were advised to go to the emergency department (ED) for additional hypertensive management, 2 of whom were subsequently hospitalized; 9 patients were advised to go to the ED in the postintervention group, and no patient was subsequently hospitalized. No adverse effects were documented from in-office clonidine administration in either cohort of patients. Conclusion: The hypertensive urgency protocol and education reduced the number of clonidine orders and hospital admissions. The increase in ED referrals needs further assessment.