• Kellie Wang and Kathryn Samai.
• Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, United States of America. Electronic address: kellie-wang@smh.com.
• Am J Emerg Med. 2020 Jan 1; 38 (1): 132-137.

BackgroundPatients with hypertensive acute heart failure (H-AHF) can decompensate rapidly and require immediate medical attention; the use of high-dose nitroglycerin is a topic of growing interest in this patient population.Objective Of The ReviewThe purpose of this review is to provide an evidence-based approach for the utilization of high-dose nitrates in the emergent management of H-AHF.DiscussionTwo randomized controlled trials, three prospective studies, two retrospective cohorts, two case series, and one case report were evaluated. Level of robust evidence and heterogeneity limit the ability to draw strong conclusions regarding the use of high-dose nitrates. Despite these limitations, high-dose nitrates appeared to have an overall beneficial effect across all studies reviewed, including lower rates of mechanical ventilation, improvement in blood pressure, shorter LOS, and lower rates of ICU admission. Adverse effects were mild and infrequently reported.ConclusionsHigh-dose nitrates are likely safe and may be effective, as demonstrated in the studies reviewed. High-dose NTG may be appropriate in H-AHF patients presenting with severe respiratory distress and SBP ≥160 mmHg or MAP ≥120 mmHg. Future well-designed randomized controlled trials are needed to elucidate optimal dosing strategies and confirm safety and efficacy of high-dose nitrates.Copyright © 2019 Elsevier Inc. All rights reserved.

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