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Early Blood Pressure Reduction by Intravenous Vasodilators Is Associated With Acute Kidney Injury in Patients With Hypertensive Acute Decompensated Heart

Circulation Journal, 2019/07/18, pp.CJ-19-0333 [Peer Reviewed Journal]

2019 THE JAPANESE CIRCULATION SOCIETY ;ISSN: 1346-9843 ;EISSN: 1347-4820 ;DOI: 10.1253/circj.CJ-19-0333

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  • Title:
    Early Blood Pressure Reduction by Intravenous Vasodilators Is Associated With Acute Kidney Injury in Patients With Hypertensive Acute Decompensated Heart
  • Author: Arao, Yoshihito ; Sawamura, Akinori ; Nakatochi, Masahiro ; Okumura, Takahiro ; Kato, Hiroo ; Oishi, Hideo ; Yamaguchi, Shogo ; Haga, Tomoaki ; Kuwayama, Tasuku ; Yokoi, Tsuyoshi ; Hiraiwa, Hiroaki ; Kondo, Toru ; Morimoto, Ryota ; Murohara, Toyoaki
  • Subjects: Acute decompensated heart failure ; Acute kidney injury ; Blood pressure reduction ; Vasodilators
  • Is Part Of: Circulation Journal, 2019/07/18, pp.CJ-19-0333
  • Description: Background:Intravenous vasodilators are commonly used in patients with hypertensive acute decompensated heart failure (ADHF), but little is known about their optimal use in blood pressure (BP) management to avoid acute kidney injury (AKI). The purpose of this study was to investigate the association between systolic BP (SBP) changes and the incidence of AKI in patients with hypertensive ADHF.Methods and Results:Post-hoc analysis was performed on a prospectively enrolled cohort. We investigated 245 patients with ADHF and SBP >140 mmHg on arrival (mean age, 76 years; 40% female). We defined “SBP-fall” as the maximum percent reduction in SBP 6 h after intravenous treatment. AKI was defined as serum creatinine (SCr) ≥0.3 mg/dL, or urine output <0.5 mL/kg/h (n=66) at 48 h. Mean SBP and SCr levels on arrival were 180 mmHg and 1.21 mg/dL, respectively. Patients with AKI had significantly larger SBP-fall than the others (36.7±15.3% vs. 27.2±15.3%, P<0.0001). Logistic regression analysis showed an odds ratio per 10% SBP-fall for AKI of 1.49 (95% confidence interval 1.29–1.90, P=0.001). SBP-fall was significantly associated with the number of concomitant used intravenous vasodilators (P=0.001). The administration of carperitide was also independently associated with increased incidence of AKI.Conclusions:Larger SBP-fall from excessive vasodilator use is associated with increased incidence of AKI in patients with hypertensive ADHF.
  • Publisher: The Japanese Circulation Society
  • Language: English
  • Identifier: ISSN: 1346-9843
    EISSN: 1347-4820
    DOI: 10.1253/circj.CJ-19-0333
  • Source: GFMER Free Medical Journals
    Alma/SFX Local Collection
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