Key result
Early intravenous vasodilator treatment with ≤25% systolic blood pressure reduction was associated with lower 1-year all-cause mortality compared to no vasodilators (HR 0.74; 95% CI 0.57-0.96; p=0.028).
Why the study?
Does early treatment with intravenous vasodilators yielding ≤25% SBP reduction improve diuretic response and reduce 1-year mortality in patients with acute heart failure?
Cohort (n=1,670)
Does early treatment with intravenous vasodilators yielding ≤25% SBP reduction improve diuretic response and reduce 1-year mortality in patients with acute heart failure?
Hazard Ratio: 0.74 (95% CI 0.57–0.96)
p-value: p=0.028
Early intravenous vasodilator therapy in acute heart failure is associated with improved diuretic response and 1-year survival, provided the subsequent systolic blood pressure reduction does not exceed 25%.
May support early IV vasodilators in acute HF with ≤25% SBP drop; hypothesis-generating and requires RCTs before practice change.
Objective: Although vasodilators are used in acute heart failure (AHF) management, there have been no clear supportive evidence regarding their routine use. Recent European guidelines recommend systolic blood pressure (SBP) reduction in the range of 25% during the first few hours after diagnosis. This study aimed to examine clinical and prognostic significance of early treatment with intravenous vasodilators in relation to their subsequent SBP reduction in hospitalised AHF. Methods: We performed post hoc analysis of 1670 consecutive patients enrolled in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure. Intravenous vasodilator use within 6 hours of hospital arrival and subsequent SBP changes were analysed. Outcomes were gauged by 1-year mortality and diuretic response (DR), defined as total urine output 6 hours posthospital arrival per 40 mg furosemide-equivalent diuretic use. Results: Over half of the patients (56.0%) were treated with intravenous vasodilators within the first 6 hours. In this vasodilator-treated cohort, 554 (59.3%) experienced SBP reduction ≤25%, while 381 (40.7%) experienced SBP reduction >25%. In patients experiencing ≤25% drop in SBP, use of vasodilator was associated with greater DR compared with no vasodilators (p<0.001). Moreover, vasodilator treatment with ≤25% drop in SBP was independently associated with lower all-cause mortality compared with those treated without vasodilators (adjusted HR 0.74, 95% CI 0.57 to 0.96, p=0.028). Conclusions: Intravenous vasodilator therapy was associated with greater DR and lower mortality, provided SBP reduction was less than 25%. Our results highlight the importance in early administration of intravenous vasodilators without causing excess SBP reduction in AHF management. Clinical trial registration: URL: http://www.umin.ac.jp/ctr/ Unique identifier: UMIN000014105.
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Kitai et al. (2018) conducted a cohort in acute heart failure (n=1,670). Early intravenous vasodilators with ≤25% systolic blood pressure reduction vs. No vasodilators was evaluated on 1-year all-cause mortality (HR 0.74, 95% CI 0.57-0.96, p=0.028). Early intravenous vasodilator treatment with ≤25% systolic blood pressure reduction was associated with lower 1-year all-cause mortality compared to no vasodilators (HR 0.74; 95% CI 0.57-0.96; p=0.028).
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