Key result
High-dose IV nitroglycerin achieves ~88% 3-hour clinical resolution vs low-dose in hypertensive pulmonary edema.
Why the study?
The study was conducted to compare the effectiveness and safety of high-dose versus low-dose intravenous nitroglycerin for hypertensive acute pulmonary edema in the emergency department.
Does high-dose intravenous nitroglycerin improve clinical resolution compared to low-dose infusion in adults with hypertensive acute pulmonary edema?
RCT (n=64)
Open-label
Parallel
No
Does high-dose intravenous nitroglycerin improve clinical resolution compared to low-dose infusion in adults with hypertensive acute pulmonary edema?
Absolute Event Rate: 87.5% vs 53.3%
p-value: p=0.003
High-dose intravenous nitroglycerin achieves more rapid clinical resolution and blood pressure reduction than low-dose infusion in hypertensive acute pulmonary edema without increasing adverse events.
High-dose nitroglycerin may be prioritized for hypertensive acute pulmonary edema; extends randomized evidence for dose-dependent efficacy in the emergency setting.
STUDY OBJECTIVE: To compare the effectiveness and safety of high-dose versus low-dose intravenous nitroglycerin for hypertensive acute pulmonary edema in the emergency department. METHODS: This open-label, pragmatic, parallel randomized controlled trial was conducted in the emergency department of a tertiary care centre in Eastern India. Adults presenting with hypertensive acute pulmonary edema (systolic blood pressure >160 mm Hg or mean arterial pressure >120 mm Hg) were randomized to receive either high-dose nitroglycerin infusion (starting at 100 μg/min, titrated up to 200 μg/min) or low-dose infusion (starting at 10 μg/min, titrated up to 100 μg/min), in addition to standard care including non-invasive ventilation and diuretics. The primary outcome was attainment of predefined clinical resolution endpoints at 3 and 6 h. Secondary outcomes included time to 25% reduction in systolic blood pressure, need for endotracheal intubation, and hypotension. RESULTS: Sixty-four patients were enrolled, with 32 assigned to each group. At 3 h, clinical resolution occurred in 28 of 32 patients (87.5%) in the high-dose group compared with 16 of 32 patients (53.3%) in the low-dose group (p = 0.003). Time to achieve a 25% reduction in systolic blood pressure was shorter in the high-dose group (p < 0.001). Two patients (6.2%) in the low-dose group required endotracheal intubation compared with none in the high-dose group. No episodes of hypotension were observed in either group. CONCLUSION: Among patients with hypertensive acute pulmonary edema, high-dose intravenous nitroglycerin achieved more rapid clinical resolution and blood pressure reduction than low-dose infusion, without an observed increase in adverse events.
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Diya et al. (2026) conducted an RCT in Hypertensive acute pulmonary edema (n=64). High-dose intravenous nitroglycerin vs. Low-dose intravenous nitroglycerin (starting at 10 μg/min, titrated up to 100 μg/min) was evaluated on Attainment of predefined clinical resolution endpoints at 3 and 6 h (p=0.003). High-dose intravenous nitroglycerin achieved clinical resolution at 3 hours in 87.5% of patients with hypertensive acute pulmonary edema compared to 53.3% with low-dose infusion (p=0.003).
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