This consensus statement proposes tailoring clinical management for hypertensive acute heart failure in the ED based on distinct pathophysiologic mechanisms rather than solely volume overload.
May warrant vasodilator strategies over diuretics alone in H-AHF; leaves open optimal ED trial designs and endpoints.
Management approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H-AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease that is based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H-AHF.
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Collins et al. (2016) studied this question.
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