Safety and efficacy of intravenous hydralazine and labetalol for the
treatment of asymptomatic hypertension in hospitalized patients: a
systematic review
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.