{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:39:45Z","timestamp":1793299185766,"version":"4.5.0"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:sec id=\"ab-ioi240078-4\"><jats:title>Importance<\/jats:title><jats:p>Asymptomatic blood pressure (BP) elevations in the hospital are commonly treated with as-needed BP medications, including recurring as-needed and 1-time administration. Veterans represent a population at risk of ischemic events from rapid lowering of BP, but the impact of as-needed BP medication use in this population is unknown.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240078-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the risks of acute kidney injury (AKI) and other outcomes from as-needed BP medication administration in a hospitalized veteran cohort.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240078-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective cohort study using target trial emulation and propensity score matching included adult veterans, who were hospitalized 3 or more days in Veterans Administration hospitals between October 1, 2015, and September 30, 2020. Participants must have been hospitalized on a non\u2013intensive care unit medical or surgical floor, must not have undergone surgery, and must have received at least 1 scheduled BP medication in the first 24 hours of admission. Participants also must have had at least 1 systolic BP more than 140 mm Hg during hospitalization. Data in this study were analyzed from April 2023 to August 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240078-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was time to first AKI occurrence during hospitalization. Secondary outcomes included greater than 25% reduction in systolic BP within 3 hours of as-needed BP medication administration and the composite outcome of myocardial infarction, stroke, or death during hospitalization.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240078-8\"><jats:title>Results<\/jats:title><jats:p>Of the 133\u202f760 veterans eligible for analysis (mean [SD] age, 71.2 [11.6] years), 96% were male. The mean (SD) baseline estimated glomerular filtration rate was 75.7 (22.7) mL\/min\/1.73m<jats:sup>2<\/jats:sup>. A total of 28\u202f526 patients (21%) received as-needed BP medication. As-needed BP medication use was associated with an increased AKI risk (adjusted hazard ratio, 1.23 [95% CI, 1.18-1.29]) compared to nonusers. Subgroup analyses showed higher AKI risk with intravenous as-needed BP medication use (compared to oral or combined oral and intravenous routes). Secondary analyses indicated as-needed BP medication users had a 1.5-fold greater risk of rapid BP reduction (95% CI, 1.39-1.62) and 1.69-fold higher rate of the composite outcome (95% CI, 1.49-1.92) compared to nonusers.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240078-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The results of this retrospective cohort study showed that as-needed BP medication use among veterans is associated with increased AKI risk. The risks and benefits of this type of BP medication use would best be determined through a prospective trial, and these data suggest that there is the necessary equipoise to conduct such a trial.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.6213","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T16:33:01Z","timestamp":1732552381000},"page":"52","source":"Crossref","is-referenced-by-count":22,"title":["As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals"],"prefix":"10.1001","volume":"185","author":[{"given":"Muna Thalji","family":"Canales","sequence":"first","affiliation":[{"name":"Medical Service, Research Service and Geriatric Research Education and Clinical Center, North Florida\/South Georgia Veterans Health System, Gainesville, Florida"},{"name":"Department of Medicine, University of Florida, 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