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Review
. 2022 May 10;35(5):433-440.
doi: 10.1093/ajh/hpac004.

Excessive Blood Pressure Response to Clonidine in Hospitalized Patients With Asymptomatic Severe Hypertension

Jonathan Hanna  1 , Lama Ghazi  2 , Yu Yamamoto  2 , Michael Simonov  2 , Tayyab Shah  1 , Francis P Wilson  2 , Aldo J Peixoto  3
Affiliations
Review

Excessive Blood Pressure Response to Clonidine in Hospitalized Patients With Asymptomatic Severe Hypertension

Jonathan Hanna et al. Am J Hypertens. .

Abstract

Background: There are limited and nonconcordant data on the rapidity and safety of blood pressure response to clonidine in the setting of asymptomatic severe hypertension. We evaluated the blood pressure response to clonidine in hospitalized patients with asymptomatic severe hypertension.

Methods: We performed a review of hospitalized, noncritically ill patients receiving clonidine within 6 hours of developing asymptomatic severe hypertension (systolic blood pressure [SBP] >180 or diastolic blood pressure [DBP] >110 mm Hg in the absence of acute hypertension-mediated target organ damage). The incidence of mean arterial pressure (MAP) reduction by ≥30% at 4 hours after clonidine was the primary endpoint.

Results: We identified 200 relevant patient encounters (median age 63 years, 48.5% women). Median time to clonidine following asymptomatic severe hypertension was 2.8 hours. A total of 20 (10%) patients had ≥30% MAP reduction within 4 hours after clonidine, and 32 (16%) patients had ≥30% reduction in either SBP, DBP, or MAP. Older age, female sex, and preexisting vascular disease were associated with ≥30% MAP reductions (P < 0.05). Only patient sex and clonidine dose of 0.3 mg were significant in multivariable models. There were 14 adverse events observed within 24 hours of administration of clonidine; most (9) were acute kidney injury. There were no ischemic (myocardial, cerebrovascular) events.

Conclusions: A substantial minority of hospitalized patients with asymptomatic severe hypertension experience precipitous blood pressure decline with clonidine, and though blood pressure declines more precipitously in women and those receiving higher doses (0.3 mg specifically), the response to clonidine is generally not predictable on clinical grounds.

Keywords: asymptomatic severe hypertension; blood pressure; clonidine; hypertension; inpatient hypertension.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Timeline schematic. This figure displays 3 time cutoffs used in the study: (a) administration of clonidine, which must have occurred within 6 hours after severe blood pressure elevation, (b) blood pressure response to clonidine, which was examined within 4 hours after clonidine administration, and (c) adverse events, which were examined within 24 hours after clonidine administration.
Figure 3.
Figure 3.
Change in blood pressure over time. These figures display change in (a) mean arterial pressure (MAP), (b) systolic blood pressure (SBP), and (c) diastolic blood pressure (DBP) at each blood pressure check within 4 hours after receiving clonidine (time = 0). Cases with ≥30% drop in pressure are colored in gray.
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