Nicardipine Versus Nitroglycerin for The Treatment of Hypertensive Acute Heart Failure Syndrome: A Single-Center Observational Study

Background: Nitroglycerin is considered a first-line agent for hypertensive acute heart failure syndromes (AHFS). In this study, we compared the effectiveness of nicardipine and nitroglycerin in patients with hypertensive AHFS. Methods: We conducted a single-center, retrospective, observational study at the intensive care unit of a Japanese hospital. Patients diagnosed with AHFS and systolic blood pressure exceeding 140 mmHg on arrival between April 2013 and August 2019 were included. The outcomes were the time to optimal blood pressure control, duration of the continuous infusion of anti-hypertensive agents, duration of positive pressure ventilation, need for additional anti-hypertensive agents, length of hospital stay, and body weight changes. Outcomes were compared between the nicardipine and nitroglycerin groups. We also compared these outcomes between the groups after excluding patients who received renal replacement therapy. Results: Forty-five patients were enrolled (25 and 20 were treated with nitroglycerin and nicardipine, respectively). The nicardipine group had a shorter time to optimal blood pressure control (1.0 [interquartile range, 1.0–3.0] h vs. 0.5 [0.5–1.0] h), shorter duration of the continuous infusion of anti-hypertensive agents (65.5 [32.5–127.5] h vs. 31.0 [18.5–61.0] h), less frequent need for additional anti-hypertensive agents (0 patients vs. 10 patients [40.0%]), and shorter length of hospital stay (19.0 [10.0–33.0] days vs. 8.0 [5.0–12.3] days) than the nitroglycerin group. The duration of positive pressure ventilation and body weight changes were similar between the groups. These outcomes were similar after excluding patients who received renal replacement therapy. Conclusions : Nicardipine may be more effective than nitroglycerin for treating hypertensive AHFS.