# PRN Blood Pressure Medication Use in VA Hospitals: A Mixed Methods Approach

> **NIH VA I21** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Background: As many as 7 out of 10 hospitalized patients experience asymptomatic blood pressure (BP)
elevations while in the hospital. However, no guidelines exist to guide the management of inpatient BP
elevations. And, literature suggests treating these elevations with short-acting “as needed” BP medications
(PRN BP), especially if asymptomatic, may be harmful. Despite this, many providers treat asymptomatic BP
elevations with PRN BP.
Significance: Adverse events due to overtreatment of inpatient BP elevations may lead to poor patient
outcomes and higher hospitalization costs. Veterans, by virtue of older age and high prevalence of co-
morbidities, are a population at high risk for adverse effects from inpatient BP treatment. Thus, it is vital to
understand the practice patterns and provider motivations for PRN BP prescribing in VA hospitals in order to
design interventions to target proper PRN BP use in hospitals. Such interventions can be tested for impact on
safety and cost attributable to this practice. This work addresses VHA HSR&D priorities of Quality and Safety
of Health Care, Health Care Value and Health Care Informatics.
Innovation and Impact: The proposed work is novel in that it leverages extensive clinical electronic health
record and administrative data and marries it with granular data from provider and nursing interviews (locally at
a single VA hospital) and a national survey to better understand the full arc of predictors and motivations for
prescribing in a low cost, timely fashion. Ultimately, the impact of this project is that it will provide fundamental
infromation that will lead to the design, development and testing of interventions aimed at optimizing provider
and nursing use of PRN BP. This intervention can be tested via cluster randomized trials to optimize related
safety and costs of care.
Specific Aims: Aim 1. To identify the prevalence of PRN BP use, and the sociodemographic and clinical
factors associated with PRN BP use among Veterans hospitalized in VA hospitals nationally from FY16-
FY20. Aim 2. To understand provider, nursing and system-level factors motivating PRN blood pressure use in
VA hospitals through qualitative research techniques
Methods: We will use VINCI resources to create a cohort from the national VHA of all Veterans consisting of
all non-intensive care unit admissions to VA hospitals in FY16-20. Using several VA data sources including the
Pharmacy Benefit Management and the Corporate Data Warehouse, we will define PRN BP use during
hospitalization and collect diagnosis codes and specific clinical data including BP and kidney function
measures. In Aim 1, will describe the prevalence of PRN BP prescribing and factors that predict prescription of
PRN BP. In Aim 2, we will complement our findings from Aim 1 through 1 on 1 interviews with providers and
nurses at a single VA tertiary care hospital to explore system-level and individual-level motivating factors for
PRN BP use. We will use themes that em...

## Key facts

- **NIH application ID:** 10424766
- **Project number:** 1I21HX003553-01
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Muna T Canales
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-05-01 → 2023-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10424766

## Citation

> US National Institutes of Health, RePORTER application 10424766, PRN Blood Pressure Medication Use in VA Hospitals: A Mixed Methods Approach (1I21HX003553-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10424766. Licensed CC0.

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