Bolus versus continuous infusion of nitroglycerin for the treatment of acute hypertensive heart failure

Abstract

Background: The use of intravenous nitroglycerin by intermittent bolus doses in hypertensive acute heart failure patients (AHF) is still unclear. Aim and Objectives: This study aimed to determine intermittent bolus nitroglycerin's effect on the use of resources, admissions to intensive care unit (ICU), hospital length of stay (LOS), and safety. Patients and Methods: This prospective, randomized, parallel, single-blind clinical study, which included patients diagnosed with hypertensive AHF, was conducted from May 2019 to October 2020 at Benha University Hospital. Two hundred patients were recruited and randomly allocated into two groups, each composed of 100 patients. Results: The prevalence of hypertension and chronic obstructive pulmonary disease patients was significantly higher in patients given intermittent boluses of nitroglycerin than in standard therapy (88.0 vs. 77.0%, P = 0.041) and (27.0 vs. 15.0%, P = 0.037), respectively. Dyslipidemia was significantly lower in patients on intermittent doses of nitroglycerin than those on standard infusion therapy (30 vs. 66%, P < 0.001). The median initial troponin was significantly higher in group I compared to group II (0.145 vs. 0.065 ng/ml, P < 0.001). Conclusion: Nitroglycerin intravenous boluses were associated with fewer ICU admissions and a shorter LOS in the hospital as opposed to ordinarily infusion therapy. In addition, the mean mechanical ventilation duration was slightly shorter. Finally, continuous nitroglycerin infusion use in AHF management is being questioned.