Intravenous enalaprilat for treatment of acute hypertensive heart failure in the emergency department.

Syed Imran Ayaz,Arushi Mahajan,Scott Millis,Craig M Sharkey,Gregory M Kwiatkowski,Rosa Tolomello,Phillip D Levy,Suprat Saely Wilson,Reba S John

doi:10.1186/s12245-016-0125-4

Abstract

BackgroundAfterload reduction with bolus enalaprilat is used by some for management of acute hypertensive heart failure (HF) but existing data on the safety and effectiveness of this practice are limited. The purpose of this study was to evaluate the clinical effects of bolus enalaprilat when administered to patients with acute hypertensive heart failure.FindingsWe performed an IRB-approved retrospective cohort study of patients who presented to the emergency department of a large urban academic hospital. Patients were identified by pharmacy record and included if they received enalaprilat intravenous (IV) bolus in the setting of acute hypertensive HF. A total of 103 patients were included. Patients were hypertensive on presentation (systolic blood pressure [SBP] = 195.2 [SD ± 32.3] mmHg) with significantly elevated mean NT-proBNP levels (3797.8 [SD ± 6523.2] pg/ml). The mean dose of enalaprilat was 1.3 [SD ± 0.7] mg, with most patients (76.7%) receiving a single 1.25 mg bolus. By 3 h postenalaprilat, SBP had decreased substantially (−30.5 mmHg) with only 2 patients (1.9%) developing hypotension. Renal function was unaffected, with no significant change in serum creatinine by 72 h. In the 30 days post-admission, patients spent an average of 23 [SD ± 7.5] days alive and out of hospital.ConclusionsIn this retrospective cohort of acute hypertensive HF patients, bolus IV enalaprilat resulted in a substantial reduction in systolic BP without adverse effect.

Highlights

Acute heart failure (AHF) can be precipitated by multiple causes, including medication non-compliance, hypertension, acute ischemia, arrhythmias, or concurrent infection [1,2,3]
In this retrospective cohort of acute hypertensive HF patients, bolus IV enalaprilat resulted in a substantial reduction in systolic blood pressure (BP) without adverse effect
Patients were identified by pharmacy record review of those who received enalaprilat by IV bolus in the emergency department (ED)

Summary

Introduction

Acute heart failure (AHF) can be precipitated by multiple causes, including medication non-compliance, hypertension, acute ischemia, arrhythmias, or concurrent infection [1,2,3]. Regardless of the cause, patients with AHF experience an acute change in signs and symptoms requiring urgent intervention and potential hospitalization [2]. It has been well documented that angiotensin-converting enzyme (ACE) inhibitors are effective in the treatment of hypertension and chronic HF [10,11,12,13,14]. Enalaprilat is a parenteral ACE Inhibitor and is the active metabolite of the orally administered pro-drug, enalapril [10, 15]. Afterload reduction with bolus enalaprilat is used by some for management of acute hypertensive heart failure (HF) but existing data on the safety and effectiveness of this practice are limited. The purpose of this study was to evaluate the clinical effects of bolus enalaprilat when administered to patients with acute hypertensive heart failure

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Conclusion