Weight adjusted nitroglycerin dosage and blood pressure response in acute hypertensive pulmonary edema: a prospective observational study

Objectives Hypertensive pulmonary edema is a life-threatening clinical picture that is frequently encountered in emergency departments and requires rapid intervention. Background The aim of this study was to evaluate the relationship between intravenous nitroglycerin (NTG) doses and body weight and body mass index (BMI) in patients admitted to the emergency department with hypertensive pulmonary edema. Methods This prospective observational study was conducted in a tertiary health care institution. Patients included were diagnosed with hypertensive pulmonary edema and treated with intravenous NTG therapy. NTG doses were titrated to achieve a 25% reduction in patients' target mean arterial pressure (MAP). The relationships between weight and BMI and total dose of NTG were statistically analyzed. Results The study included 66 patients. Body weight was significantly positively correlated with NTG total dose (r = 0.61) (p < 0.01). Similarly, significant correlation were found between BMI and NTG total doses (r = 0.71). The mean NTG dose was significantly higher in patients who failed to reach the target MAP (6.15 µg/kg vs. 2.51 µg/kg, p < 0.001). ROC analysis showed that the optimal cut-off value for NTG dose per kilogram was 4.12 µg/kg, with a sensitivity and specificity of 97% (AUC: 0.99, 95% CI: 0.98–0.99). Conclusion NTG dose requirement was found to be closely related to patient weight and BMI. Individualized dosing strategies in the treatment of hypertensive pulmonary edema may improve clinical outcomes. A threshold of 4.12 µg/kg may be recommended as an effective dose threshold to achieve target blood pressure.