Comparing antihypertensive strategies in hypertensive emergencies with heart failure

6.2 million Americans live with heart failure (HF) and are at risk for hospitalization due to hypertensive emergencies. Optimal treatment strategy for acute hypertensive heart failure remains unclear. Our study investigates what treatment modality is most effective in achieving guideline-directed blood pressure control.

This was a retrospective cohort study of hypertensive emergency with HF exacerbation from 2019 to 2021. The primary outcome was length of time for a 25 % decrease in systolic BP or BP of <160/110 mmHg. Patients were categorized into 4 groups: only oral medications, IV bolus, continuous IV infusion (CIVI), or both CIVI and IV bolus.

A total of 120 admissions were analyzed after applying exclusion criteria to a total of 1041 reviewed. Groups were well balanced and similar in characteristics. There were no significant differences in achieving the target BP among groups (ANOVA p = 0.662). CIVI had a nonsignificant trend towards achieving target BP fastest, however, IV bolus administration resulted in significantly fewer days in ICU compared to CIVI without a significant change in total hospital length of stay. Acute kidney injury was the most common complication, occuring in 31 (25.83 %) patients without differences across groups (p = 0.825).

Acute hypertensive heart failure was managed adequately with any treatment modality. Use of IV bolus therapy in these patients was associated with shorter ICU length of stay. Our results add to growing evidence that hypertensive emergencies may be less clinically significant than previously thought.