From the Research
In a CHF exacerbation, blood pressure should be maintained at a target of less than 130/80 mmHg, though careful individualization is necessary, as recommended by the most recent and highest quality study 1.
Key Considerations
- First-line medications include ACE inhibitors (such as lisinopril 10-40 mg daily or enalapril 2.5-20 mg twice daily) or ARBs (such as losartan 25-100 mg daily) if ACE inhibitors are not tolerated.
- Beta-blockers (metoprolol succinate 25-200 mg daily or carvedilol 3.125-25 mg twice daily) should be continued if already prescribed but initiated at low doses and only after stabilization if newly started.
- Diuretics like furosemide (20-80 mg daily or twice daily) help manage fluid overload while controlling BP.
- During acute exacerbations, IV medications may be necessary, with careful monitoring to avoid hypotension which could worsen cardiac output and organ perfusion.
Monitoring and Adjustments
- Blood pressure should be checked frequently, at least every 4 hours during hospitalization, with medication adjustments as needed.
- This careful BP control helps reduce cardiac workload, prevents further myocardial damage, and improves outcomes by maintaining optimal perfusion while reducing the strain on the weakened heart, as supported by studies such as 2 and 3.
Additional Recommendations
- Treatment should focus on the underlying disease process, with guidelines focusing primarily on blood pressure and hemodynamic status, as outlined in 1.
- Patients with AHF with flash pulmonary edema should receive nitroglycerin and noninvasive positive pressure ventilation, with consideration of an angiotensin-converting enzyme inhibitor, while monitoring for hypotension.