• Geoffrey S Kelly, Lindsey A Branstetter, Tim P Moran, Nathan Hanzelka, and Claudia D Cooper.
• Emory University School of Medicine, Department of Emergency Medicine, 550 W Peachtree St NW, Atlanta, GA 30308, United States of America.. Electronic address: gskelly2@gmail.com.
• Am J Emerg Med. 2023 Mar 1; 65: 717571-75.

BackgroundNitroglycerin (NTG) is commonly used for the management of pulmonary edema in acute heart failure presentations. Although commonly initiated at low infusion rates, higher infusion rates have favorable pharmacodynamic properties and may improve outcomes in the management of acute pulmonary edema.ObjectivesTo characterize the clinical outcomes including the time to resolution of severe hypertension when using an initial low dose (<100 μg/min) versus high-dose (≥100 μg/min) strategy.MethodsThis was a retrospective study performed at a single, tertiary academic emergency department in Atlanta, GA. We describe the blood pressure effects and key safety outcomes (intubation, hypotension, intensive care unit admissions) during the first hour of treatment of acute pulmonary edema.Results41 patients were included in the final sample. 27 (66%) received low dose NTG and 14 (34%) received high dose NTG. The high dose group reached their blood pressure faster on average (hazard ratio = 3.5, 95% CI: 1.2-10.1). 8/14 (57%) of patients in the high dose group reached their BP target within the first hour of treatment, compared to 6/27 (22%) in the low dose group. Observed incidence of safety outcomes were similar between the two groups.ConclusionsHigher initial NTG doses may be an effective way to decrease times to achieve blood pressure targets and should be the focus of future trials.Copyright © 2022 Elsevier Inc. All rights reserved.

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