Blood Pressure Reduction in Hypertensive Acute Heart Failure.
Nicholas Eric HarrisonPeter PangSean CollinsPhillip LevyPublished in: Current hypertension reports (2021)
Despite numerous AHF vasodilator clinical trials in the past two decades, virtually none has studied a population where vasoconstriction is the predominant physiology, and with the agents and doses most commonly used in contemporary practice. AHF patients are remarkably heterogenous by vascular tone, and this heterogeneity is not always discernible through BP or clinical exam. Emerging data suggest that diastolic BP may be a stronger correlate of vascular tone in AHF than systolic BP, despite the latter historically serving as a key inclusion criterion for vasodilator clinical trials. Existing data are limited. A clinical trial that evaluates vasodilators in a manner of use consistent with contemporary practice, specifically within the subpopulation of patients with true H-AHF, is greatly needed. Until then, observational data supports long-standing vasodilators such as nitroglycerin, administered by IV bolus, and with goal reduction of SBP ≤25% as a safe first-line approach for patients with severe H-AHF presentations.
Keyphrases
- clinical trial
- blood pressure
- electronic health record
- acute heart failure
- end stage renal disease
- ejection fraction
- left ventricular
- big data
- heart failure
- primary care
- phase ii
- healthcare
- hypertensive patients
- chronic kidney disease
- heart rate
- peritoneal dialysis
- double blind
- type diabetes
- patient reported outcomes
- single cell
- early onset
- study protocol
- randomized controlled trial
- skeletal muscle
- deep learning