Effectiveness of Short-Acting Oral Antihypertensives in Asymptomatic Markedly Elevated Blood Pressure: An Inverse Probability Treatment Weighted Study
Bibliographic record
Abstract
Background: Although guidelines recommend gradual blood pressure (BP) reduction in asymptomatic markedly elevated BP (AMEBP), short-acting oral antihypertensives are often used despite limited evidence - driven by healthcare providers' concerns or institutional policies - thereby increasing system burden. This study aimed to identify practical regimens enabling safe, timely discharge and continuity of care. Methods: This retrospective cohort included patients with AMEBP (systolic BP > 180 mm Hg and/or diastolic BP > 110 mm Hg), who presented to the emergency department (ED) of Lampang Hospital between January and December 2023. Oral regimens included captopril, hydralazine, metoprolol (25 mg each), or combinations. The outcome was mean arterial pressure (MAP) reduction within 60 min, classified as no reduction (< 10%), appropriate reduction (10-15%), or over-reduction (> 15%). Inverse probability of treatment weighting (IPTW) adjusted for regimen selection, and multinomial odds ratios (mORs) with 95% confidence intervals (CIs) were reported. Results: Among 158 patients (mean age 60 years; 67.1% female), baseline MAP was 142.4 ± 16.2 mm Hg. Captopril and hydralazine monotherapy were most likely to achieve appropriate reduction (captopril: mOR: 2.91; 95% CI: 0.96, 8.76; P = 0.058; hydralazine: mOR: 2.76; 95% CI: 0.84, 9.11; P = 0.096). Metoprolol was associated with inappropriate response, while captopril plus hydralazine had highest odds of over-reduction (mOR: 3.04; 95% CI: 1.02, 9.00; P = 0.045). Conclusions: Although urgent BP reduction is not routinely recommended in the ED, oral captopril appears to be a reasonable first-line option when clinically necessary, while hydralazine may be a suitable alternative. Combination of these two drugs should be used with caution due to the risk of excessive MAP reduction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".