Key result
Larger vasodilator-induced early blood pressure drops linked to increased acute kidney injury in hypertensive ADHF.
Why the study?
Little is known about the optimal use of intravenous vasodilators for blood pressure management to avoid acute kidney injury in hypertensive acute decompensated heart failure.
Does aggressive early reduction in systolic blood pressure by intravenous vasodilators increase the incidence of acute kidney injury in patients with hypertensive acute decompensated heart failure?
Cohort (n=245)
Does aggressive early reduction in systolic blood pressure by intravenous vasodilators increase the incidence of acute kidney injury in patients with hypertensive acute decompensated heart failure?
Odds Ratio: 1.49 (95% CI 1.29–1.9)
p-value: p=0.001
Aggressive early reduction of systolic blood pressure using intravenous vasodilators is associated with an increased risk of acute kidney injury without improving in-hospital outcomes in patients with hypertensive ADHF.
Rapid early SBP reduction was associated with higher AKI risk in hypertensive ADHF; hypothesis-generating for safer targets in randomized trials.
BACKGROUND: Intravenous vasodilators are commonly used in patients with hypertensive acute decompensated heart failure (ADHF), but little is known about their optimal use in blood pressure (BP) management to avoid acute kidney injury (AKI). The purpose of this study was to investigate the association between systolic BP (SBP) changes and the incidence of AKI in patients with hypertensive ADHF. METHODS AND RESULTS: Post-hoc analysis was performed on a prospectively enrolled cohort. We investigated 245 patients with ADHF and SBP >140 mmHg on arrival (mean age, 76 years; 40% female). We defined "SBP-fall" as the maximum percent reduction in SBP 6 h after intravenous treatment. AKI was defined as serum creatinine (SCr) ≥0.3 mg/dL, or urine output <0.5 mL/kg/h (n=66) at 48 h. Mean SBP and SCr levels on arrival were 180 mmHg and 1.21 mg/dL, respectively. Patients with AKI had significantly larger SBP-fall than the others (36.7±15.3% vs. 27.2±15.3%, P<0.0001). Logistic regression analysis showed an odds ratio per 10% SBP-fall for AKI of 1.49 (95% confidence interval 1.29-1.90, P=0.001). SBP-fall was significantly associated with the number of concomitant used intravenous vasodilators (P=0.001). The administration of carperitide was also independently associated with increased incidence of AKI. CONCLUSIONS: Larger SBP-fall from excessive vasodilator use is associated with increased incidence of AKI in patients with hypertensive ADHF.
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Arao et al. (2019) conducted a cohort in Hypertensive acute decompensated heart failure (n=245). Systolic blood pressure reduction (SBP-fall) vs. Less or no reduction in systolic blood pressure was evaluated on Acute kidney injury (AKI) at 48 hours (OR 1.49 per 10% SBP-fall, 95% CI 1.29-1.90, p=0.001). Larger early systolic blood pressure reduction from intravenous vasodilators was significantly associated with an increased incidence of acute kidney injury (OR 1.49 per 10% SBP-fall, p=0.001) in patients with hypertensive ADHF.
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