Effects of urapidil and nitroglycerin for treatment of hypertension and atrial fibrillation in elderly patients with acute heart failure

Objective Background Acute heart failure (AHF) is a complex clinical syndrome responsible for high morbidity and mortality and frequently complicated by concomitant hypertension and atrial fibrillation (AF). Despite advances in the management of heart failure, the prognosis of these patients remains poor and there is a critical need for new treatment strategies improving the clinical outcomes.The aim of this study was to evaluate whether a1-blocker, urapidil, provides additional therapeutic benefits compared to nitroglycerin(NG)in treatment of acute heart failure complicated by hypertension and atrial fibrillation in elderly patients. Methods Fifty-eight elderly consecutive patients from Cardiology Department of Xuan Wu Hospital were randomized into 2 groups that received treatment with urapidil or NG.All patients accepted normal treatments containing diuretic, ACEI, and cardiac stimulant.Patients in control group (n=28) were treated with NG 5-10 μg/min intravenously, while those in case group (n=30) were treated with urapidil 50-100 μg/min intravenously.The duration was 7 days.The blood pressure and heart rate before treatment and 24, 48, 72 hours, 7 days after treatment were compared between the two groups, NT-proBNP, LVEDD, EDV, ejection fraction (EF) and cardiac index (CI) were also compared between the two groups. Results Patients receiving urapidil had significantly lower systolic BP than those in NG group (P<0.05). Moreover, patients in urapidil group showed lower NT-proBNP levels, LVEDD and EDV but higher EF (t=2.206, P<0.05), CI(t=3.13, P<0.05) compared to NG group.There was no reflectively heart rate accelerating in case group.Urapidil showed no adverse influence on blood glucose, cholesterol and triglyceride.Patients receiving urapidil had significantly less side effects than those in NG group (P<0.05). Conclusions Urapidil demonstrated better efficacy and less side effects than nitroglycerin on lowering and stabilizing systolic BP, attenuating cardiac afterload and improving cardiac function.Urapidil is a therapeutic option for acute heart failure patients complicated with hypertension and atrial fibrillation. Key words: Hypertension; Atrial fibrillation; Heart failure; Urapidil