Deprescribing Pro Re Nata Antihypertensives in the Hospital An Implementation Science Pilot Study Based on the COM-B Framework

Elevated blood pressure is a common occurrence in acute care settings irrespective of the reason for hospitalization. A large body of available evidence suggests possible harm from intensive hypertension management when there is no evidence of end-organ damage, otherwise known as asymptomatic hypertension (HTN). Despite this, Pro Re Nata (PRN) antihypertensives are commonly prescribed to hospitalized adults and utilized to treat asymptomatic hypertension. This practice contributes to patient harm and is considered low value care. So far, there is limited evidence to guide interventions that can successfully and consistently deprescribe PRN antihypertensive use in acute care settings. To address this gap, we conducted a pilot study in which we developed an intervention bundle using implementation science concepts based on the COM-B framework. Our results showed a significant decrease in the use of PRN antihypertensive prescriptions for hospitalized adults by hospitalist providers, especially following the delivery of high-fidelity interventions, This pilot was conducted in a single health care system comprising multiple hospitals. Due to their low cost and easy adaptability, we believe that the methods described here can be reproduced widely to minimize patient harm and allow ongoing evaluation of practices to address elevated blood pressure in acute settings. Further, this study demonstrates the feasibility of integrating implementation science principles into responsible management of hypertension among hospitalized adults based on available evidence.