Goal-directed Afterload Reduction in Acute Congestive Cardiac Decompensation Study

• Status: Completed
• Trial end date: 2019-02-21
• Target enrollment: 0
• Participant gender: All

Summary

The purpose of this study is to determine whether an early goal-directed decrement of preload and afterload with a target systolic blood pressure of 90-110 mmHg by aggressive vasodilatation in patients with acute HF in the non-ICU setting is safe, and leads to a better clinical and economical outcome

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University Hospital, Basel, Switzerland
• Treatments: Candesartan cilexetil; Nitroglycerin

Criteria

Inclusion Criteria:

• Acute HF expressed by acute dyspnea New York Heart Association (NYHA) class III or IV, and a BNP-level ≥ 500 pg/ml. The diagnosis of acute HF is additionally based on typical symptoms and clinical findings, supported by appropriate investigations such as ECG, chest X-ray, and Doppler-echocardiography as recommended by current ESC guidelines on the diagnosis and treatment of acute HF

Exclusion Criteria:

• Cardiopulmonary resuscitation < 7 days

• Cardiogenic shock, ST-elevation myocardial infarction, or other clinical conditions that require immediate ICU admission or urgent PTCA

• Systolic blood pressure lower than 100 mmHg at presentation

• Primary rhythmogenic cause of acute decompensation (ventricular tachycardia, reentry tachycardia, atrial fibrillation or atrial flutter with a ventricular rate exceeding 140 beats per minute)

• NSTEMI as primary diagnosis

• Severe aortic stenosis

• Adult congenital heart disease as primary cause of acute HF

• Hypertrophic obstructive cardiomyopathy

• Chronic kidney disease with creatinin levels > 250 µmol/l

• Bilateral renal artery stenosis

• Severe sepsis or other causes of high output failure

• Cirrhosis of the liver CHILD class C

• Previous adverse reactions to nitrates