title: Intravenous enalaprilat for treatment of acute hypertensive heart failure in the emergency department.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  We 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 post-enalaprilat, 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.
  
  
  CONCLUSIONS
  In this retrospective cohort of acute hypertensive HF patients, bolus IV enalaprilat resulted in a substantial reduction in systolic BP without adverse effect.
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA. sayaz@med.wayne.edu.
authors.forename: Syed Imran
authors.initials: SI
authors.lastname: Ayaz
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Sharkey
authors.affiliation: Detroit Receiving Hospital, 4201 St. Antoine, Detroit, MI, 48201, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Kwiatkowski
authors.affiliation: Detroit Receiving Hospital, 4201 St. Antoine, Detroit, MI, 48201, USA.
authors.forename: Suprat Saely
authors.initials: SS
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA.
authors.forename: Reba S
authors.initials: RS
authors.lastname: John
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA.
authors.forename: Rosa
authors.initials: R
authors.lastname: Tolomello
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA.
authors.forename: Arushi
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Millis
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA.|Detroit Receiving Hospital, 4201 St. Antoine, Detroit, MI, 48201, USA.|Cardiovascular Research Institute, Wayne State University School of Medicine, 540 East Canfield, Detroit, MI, 48201, USA.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levy
keywords: Acute heart failure; Acute hypertensive heart failure; Enalaprilat