Inpatient Insights
APhA Staff
Can baxdrostat reduce systolic BP in patients with hypertension?
It is widely known that aldosterone dysregulation plays a significant role in hard-to-control hypertension. Investigators conducted a phase 3, multinational, double-blind, randomized, placebo-controlled trial to determine if the addition of baxdrostat, an aldosterone synthase inhibitor, can reduce the seated systolic BP of adult patients with uncontrolled or resistant hypertension.
The participants in the study included almost 800 patients with a seated systolic BP between 140 mm Hg and 170 mm Hg despite treatment with two antihypertensive medications (uncontrolled hypertension) or three or more such medications (resistant hypertension), including a diuretic.
After a 2-week placebo run-in period, patients were randomly assigned in a 1:1:1 ratio to three groups. One group received baxdrostat at a dose of 1 mg, one group received baxdrostat at a dose of 2 mg, and one group a placebo once daily for 12 weeks. The primary end point was the change in seated systolic BP from baseline to week 12.
At 12 weeks, the change from baseline was –14.5 mm Hg for the group receiving 1 mg baxdrostat, –15.7 mm Hg for the group receiving 2 mg baxdrostat, and –5.8 mm Hg for the placebo group. The estimated placebo-corrected difference was –8.7 mm Hg for the 1 mg baxdrostat group and –9.8 mm Hg for the 2 mg baxdrostat group. The study was published in the October 9, 2025, issue of NEJM. ■
Flu vaccination improves outcomes for patients with acute heart failure
Although influenza vaccination is widely used to prevent death and serious illness in vulnerable populations, few people are vaccinated in many parts of the world. A group of researchers from China and Australia conducted a parallel group, controlled randomized trial to determine whether influenza vaccination can improve the outcome of patients after an episode of acute heart failure requiring admission to a hospital in China.
The study involved 196 hospitals with the capability of establishing a point-of-care service to provide free influenza vaccination to a sufficient number of patients before their discharge over three winter seasons in China. Hospitals were randomized (1:1) each year, stratified by province for each season, to include eligible adult patients with moderate to severe heart failure and no contraindication to influenza vaccination. Overall, almost 7,800 patients were enrolled in the study, each either receiving usual care or usual care and an influenza vaccination. The primary outcome was a composite of all-cause mortality or any hospital readmission over 12 months, excluding events that occurred within 30 days after hospital discharge at all sites and in the summer season only for sites in northern China.
The findings, which were published in the September 6, 2025, issue of The Lancet, showed that the primary outcome occurred in 41% of patients in the vaccination group and in 47% of patients in the usual care group. The incidence of a serious adverse event was significantly lower in the vaccination group. The authors concluded that integration of influenza vaccination into inpatient care could offer a widely applicable strategy for high-risk patients. ■
Is phenobarbital appropriate for treatment of alcohol withdrawal?
Benzodiazepines are traditionally used for treating alcohol withdrawal syndrome (AWS) but can be addictive and lead to adverse reactions. Phenobarbital has long been used as an alternative but has recently gained traction in hospitals, with the American Society of Addiction Medicine recommending it as a first-line AWS treatment when prescribed by experienced practitioners.
However, the safety and effectiveness of an EHR order set used across all care locations has not been studied. Researchers at the University of Washington and Harborview Medical Center (Seattle) conducted a retrospective quality improvement study at a 281-bed community hospital, including all hospitalized adults treated for AWS 11 months before and 12 months after implementation of a phenobarbital EHR order set.
The study compared outcomes of patients before and after implementation of a phenobarbital order set for I.V. weight-based phenobarbital loading (10 or 15 mg/kg). AWS symptoms resolved more rapidly after implementation, with a 4.2- to 5.0-point reduction in daily maximum Clinical Institute Withdrawal Assessment of Alcohol Scale Revised scores at 24 to 96 hours from hospital presentation, a 30.1-hour reduction in AWS treatment duration, and 2.2-day reduction in time to hospital discharge. Safety outcomes did not significantly differ before and after implementation.
The authors concluded that the results of the study, published online in JAMA Network Open on August 25, 2025, support the broader adoption of phenobarbital-based AWS treatment across diverse hospital settings. ■
Gabapentin may not be effective for pain management after major surgery
Gabapentin, an anticonvulsant medication used to treat neuropathic pain and epileptic disorders, is often added to analgesic regimens during and after surgery to reduce opioid use while controlling pain. However, guidelines vary and there is little evidence to show its effectiveness for this population. Investigators conducted a multicenter, double-blinded randomized controlled trial among adults undergoing major cardiac, thoracic, or abdominal surgery to assess the effectiveness of gabapentin as part of multimodal analgesia for managing acute postoperative pain.
Patients were randomized to receive either gabapentin (600 mg before surgery, 300 mg twice daily for 2 days after surgery) or placebo. The primary outcome was length of hospital stay, and secondary outcomes included acute and chronic pain, total opioid use, adverse health events, and health-related quality of life. Patients were followed up daily in-hospital until discharge and then at 4 weeks and 4 months after surgery.
The study, published in the October 2025 issue of Anesthesiology, involved a total of 1,196 patients (500 who underwent cardiac surgery, 346 who had thoracic surgery, and 350 who underwent abdominal surgery). The median length of hospital stay was similar in the two groups. Overall, 384 participants experienced one or more serious adverse events—31.7% of the gabapentin group and 32.6% of the placebo group, with some variation across surgical specialties. The authors suggested that their findings indicate that gabapentin should not be used routinely as part of the analgesic regimen in this surgical population. ■