{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T01:46:23Z","timestamp":1768095983247,"version":"3.49.0"},"reference-count":34,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2018,6,13]]},"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Although vasodilators are used in acute heart failure (AHF) management, there have been no clear supportive evidence regarding their routine use. Recent European guidelines recommend systolic blood pressure (SBP) reduction in the range of 25% during the first few hours after diagnosis. This study aimed to examine clinical and prognostic significance of early treatment with intravenous vasodilators in relation to their subsequent SBP reduction in hospitalised AHF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed post hoc analysis of 1670 consecutive patients enrolled in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure. Intravenous vasodilator use within 6\u2009hours of hospital arrival and subsequent SBP changes were analysed. Outcomes were gauged by 1-year mortality and diuretic response (DR), defined as total urine output 6\u2009hours posthospital arrival per 40\u2009mg furosemide-equivalent diuretic use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over half of the patients (56.0%) were treated with intravenous vasodilators within the first 6\u2009hours. In this vasodilator-treated cohort, 554 (59.3%) experienced SBP reduction \u226425%, while 381 (40.7%) experienced SBP reduction &gt;25%. In patients experiencing \u226425%\u2009drop in SBP, use of vasodilator was associated with greater DR compared with no vasodilators (p&lt;0.001). Moreover, vasodilator treatment with \u226425%\u2009drop in SBP was independently associated with lower all-cause mortality compared with those treated without vasodilators (adjusted HR 0.74, 95% CI 0.57 to 0.96, p=0.028).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Intravenous vasodilator therapy was associated with greater DR and lower mortality, provided SBP reduction was less than 25%. Our results highlight the importance in early administration of intravenous vasodilators without causing excess SBP reduction in AHF management.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trial registration<\/jats:title>\n                  <jats:p>URL: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.umin.ac.jp\/ctr\/\" ext-link-type=\"uri\">http:\/\/www.umin.ac.jp\/ctr\/<\/jats:ext-link> Unique identifier: UMIN000014105.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2018-000845","type":"journal-article","created":{"date-parts":[[2018,7,11]],"date-time":"2018-07-11T08:41:05Z","timestamp":1531298465000},"page":"e000845","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Impact of early treatment with intravenous vasodilators and blood pressure reduction in acute heart failure"],"prefix":"10.1136","volume":"5","author":[{"given":"Takeshi","family":"Kitai","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA"},{"name":"Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W H Wilson","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA"},{"name":"Department of Cellular and Molecular Medicine, Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA"},{"name":"Center for Clinical Genomics, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Xanthopoulos","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryosuke","family":"Murai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takafumi","family":"Yamane","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kitae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shogo","family":"Oishi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiichi","family":"Akiyama","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayoshi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keisuke","family":"Kida","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Okumura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuichiro","family":"Kaji","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuya","family":"Matsue","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"},{"name":"Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,11]]},"reference":[{"key":"2025081710373380000_5.2.e000845.1","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1002\/ejhf.123","article-title":"The role of intravenous vasodilators in acute heart failure management","volume":"16","author":"Piper","year":"2014","journal-title":"Eur J Heart 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