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[Sublingual nitroglycerin or intravenous enalaprilat in preclinical treatment of hypertensive patients with pulmonary edema].
Z Kardiol. 1999 Mar; 88(3):208-14.ZK

Abstract

In a prospectively designed randomized study, we compared the efficacy of sublingual nitroglycerine and intravenous enalaprilat in the out-of-hospital treatment of 46 hypertensive patients with pulmonary edema (defined as rales over both lungs and systolic blood pressure > 200 mm Hg and diastolic blood pressure > 100 mg). The out-of-hospital treatment consists of oxygen (6 Ll/min) via a face mask, furosemide 80 mg i.v., opioids 10 mg s.c., and either sublingual nitroglycerine (n = 23; initial dose: 0.8 mg; repetitive application of 0.8 mg every 10 min until a cumulative dose of 3.2 mg) or intravenous enalaprilat (initial dose: 2.5 mg; repetitive application of 2.5 mg every 30 min until a cumulative dose of 10 mg). The aim of the antihypertensive treatment was a reduction of systolic blood pressure below 160 mm Hg and diastolic blood pressure below 90 mm Hg until admission to the emergency department. In the emergency room, an arterial and venous blood sample was taken to determine the respiratory (pO2, pCO2) and metabolic status (pH value; base-excess; serum lactate) of the patient. Successful antihypertensive treatment was observed in 13/23 (57%) patients of the enalaprilat group and 15/23 (65%) patients of the nitroglycerine group (p = 0.54). Systolic and diastolic blood pressure on admission were similar in both treatment groups (systolic RR: enalaprilat: 179 [31] mm Hg; nitroglycerine: 184 [38] mm Hg; p = 0.59; diastolic RR: enalaprilat: 96 [14] mm Hg; nitroglycerine: 101 [14] mm Hg; p = 0.12). No significant differences were observed between the enalaprilat and the nitroglycerine groups concerning respiratory and metabolic parameters on admission (pO2: 67 [15] vs. 64 [17] mm Hg; p = 0.50; pCO2: 46 [9] vs. 47 [13]; p = 0.75; pH value: 7.27 [0.12] vs. 7.27 [0.09]; p = 0.98; BE: -4.2 [3.7] vs. -5.7 [4.1]; p = 0.23; lactate: 4.2 [3.3] vs. 4.2 [2.7]; p = 0.98). Intravenous enalaprilat did not exhibit any advantage compared to nitroglycerine in terms of blood pressure reduction or respiratory and metabolic parameters on admission to the emergency room. We conclude that enalaprilat is no substitute for nitroglycerine in the out-of-hospital treatment of hypertensive patients with pulmonary edema.

Authors+Show Affiliations

Hirschl MM
Abt. für Notfallmedizin Universität Wien, Osterreich.
Schreiber W
No affiliation info available
Woisetschläger C
No affiliation info available
Kaff A
No affiliation info available
Raab H
No affiliation info available

MeSH

Administration, SublingualAdultAgedAged, 80 and overBlood PressureEmergency Medical ServicesEnalaprilatFemaleHumansHypertensionInfusions, IntravenousMaleMiddle AgedNitroglycerinOxygenProspective StudiesPulmonary EdemaTreatment OutcomeVasodilator Agents

Pub Type(s)

Clinical Trial
Comparative Study
English Abstract
Journal Article
Randomized Controlled Trial

Language

ger

PubMed ID

10355071

Citation

Hirschl, M M., et al. "[Sublingual Nitroglycerin or Intravenous Enalaprilat in Preclinical Treatment of Hypertensive Patients With Pulmonary Edema]." Zeitschrift Fur Kardiologie, vol. 88, no. 3, 1999, pp. 208-14.
Hirschl MM, Schreiber W, Woisetschläger C, et al. [Sublingual nitroglycerin or intravenous enalaprilat in preclinical treatment of hypertensive patients with pulmonary edema]. Z Kardiol. 1999;88(3):208-14.
Hirschl, M. M., Schreiber, W., Woisetschläger, C., Kaff, A., & Raab, H. (1999). [Sublingual nitroglycerin or intravenous enalaprilat in preclinical treatment of hypertensive patients with pulmonary edema]. Zeitschrift Fur Kardiologie, 88(3), 208-14.
Hirschl MM, et al. [Sublingual Nitroglycerin or Intravenous Enalaprilat in Preclinical Treatment of Hypertensive Patients With Pulmonary Edema]. Z Kardiol. 1999;88(3):208-14. PubMed PMID: 10355071.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Sublingual nitroglycerin or intravenous enalaprilat in preclinical treatment of hypertensive patients with pulmonary edema]. AU - Hirschl,M M, AU - Schreiber,W, AU - Woisetschläger,C, AU - Kaff,A, AU - Raab,H, PY - 1999/6/4/pubmed PY - 1999/6/4/medline PY - 1999/6/4/entrez SP - 208 EP - 14 JF - Zeitschrift fur Kardiologie JO - Z Kardiol VL - 88 IS - 3 N2 - In a prospectively designed randomized study, we compared the efficacy of sublingual nitroglycerine and intravenous enalaprilat in the out-of-hospital treatment of 46 hypertensive patients with pulmonary edema (defined as rales over both lungs and systolic blood pressure > 200 mm Hg and diastolic blood pressure > 100 mg). The out-of-hospital treatment consists of oxygen (6 Ll/min) via a face mask, furosemide 80 mg i.v., opioids 10 mg s.c., and either sublingual nitroglycerine (n = 23; initial dose: 0.8 mg; repetitive application of 0.8 mg every 10 min until a cumulative dose of 3.2 mg) or intravenous enalaprilat (initial dose: 2.5 mg; repetitive application of 2.5 mg every 30 min until a cumulative dose of 10 mg). The aim of the antihypertensive treatment was a reduction of systolic blood pressure below 160 mm Hg and diastolic blood pressure below 90 mm Hg until admission to the emergency department. In the emergency room, an arterial and venous blood sample was taken to determine the respiratory (pO2, pCO2) and metabolic status (pH value; base-excess; serum lactate) of the patient. Successful antihypertensive treatment was observed in 13/23 (57%) patients of the enalaprilat group and 15/23 (65%) patients of the nitroglycerine group (p = 0.54). Systolic and diastolic blood pressure on admission were similar in both treatment groups (systolic RR: enalaprilat: 179 [31] mm Hg; nitroglycerine: 184 [38] mm Hg; p = 0.59; diastolic RR: enalaprilat: 96 [14] mm Hg; nitroglycerine: 101 [14] mm Hg; p = 0.12). No significant differences were observed between the enalaprilat and the nitroglycerine groups concerning respiratory and metabolic parameters on admission (pO2: 67 [15] vs. 64 [17] mm Hg; p = 0.50; pCO2: 46 [9] vs. 47 [13]; p = 0.75; pH value: 7.27 [0.12] vs. 7.27 [0.09]; p = 0.98; BE: -4.2 [3.7] vs. -5.7 [4.1]; p = 0.23; lactate: 4.2 [3.3] vs. 4.2 [2.7]; p = 0.98). Intravenous enalaprilat did not exhibit any advantage compared to nitroglycerine in terms of blood pressure reduction or respiratory and metabolic parameters on admission to the emergency room. We conclude that enalaprilat is no substitute for nitroglycerine in the out-of-hospital treatment of hypertensive patients with pulmonary edema. SN - 0300-5860 UR - https://www.unboundmedicine.com/medline/citation/10355071/[Sublingual_nitroglycerin_or_intravenous_enalaprilat_in_preclinical_treatment_of_hypertensive_patients_with_pulmonary_edema]_ L2 - https://dx.doi.org/10.1007/s003920050277 DB - PRIME DP - Unbound Medicine ER -