Weight adjusted nitroglycerin dosage and blood pressure response in acute hypertensive pulmonary edema: a prospective...

Hypertensive acute pulmonary edema is a life-threatening condition requiring rapid blood pressure control in the emergency department. This study evaluated the relationship between intravenous nitroglycerin (NTG) dose requirements, and body weight and body mass index (BMI). This single-center, prospective observational study included 66 patients presenting with hypertensive acute pulmonary edema. Intravenous NTG was initiated at 5 µg/min and titrated every 5 min according to clinical response, without an initial bolus or additional vasoactive agents. The primary endpoint was defined as a ≥ 25% reduction in systolic blood pressure within the first 20 min after NTG initiation. Correlation analyses were performed to assess the associations between NTG dose, body weight, and BMI. Receiver operating characteristic (ROC) analysis was used to determine the optimal weight-adjusted NTG dose for early hemodynamic response. Significant positive correlations were observed between total NTG dose and body weight (r = 0.61, p < 0.01) as well as BMI (r = 0.71, p < 0.01). The ROC analysis demonstrated excellent discriminatory performance for NTG dose per kilogram (AUC = 0.99). An optimal cut-off value of 4.12 µg/kg yielded a sensitivity and specificity of 97%. Stratified analyses based on baseline systolic blood pressure confirmed the robustness of these findings across different hypertension severities. Intravenous NTG dose requirements in hypertensive pulmonary edema are strongly associated with body weight and BMI. A weight-adjusted NTG dosing approach may facilitate earlier hemodynamic control and support more rational initial dosing strategies. Larger multicenter studies are needed to confirm these findings.