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      Urapidil, compared to nitroglycerin, has better clinical safety in the treatment of hypertensive patients with acute heart failure: a meta-analysis

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          The application of urapidil for treating hypertensive patients with acute heart failure in the emergency department remains controversial. Our objective was to organize the relevant articles and assess the clinical indexes between urapidil and nitroglycerin.

          Materials and methods

          PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure were searched for randomized studies that compared urapidil treatment with nitroglycerin treatment for hypertensive patients with acute heart failure. The risk ratio, with 95% CI, was calculated by using a corresponding effects model, according to the value of I 2.


          Seven randomized controlled trials were identified, in order to compare the clinical indexes. On comparing the clinical indexes, the urapidil group was found to be better than the nitroglycerin group in regard to left ventricular ejection fraction, systolic blood pressure, N-terminal prohormone of brain natriuretic peptide, left ventricular end-diastolic volume, cardiac index, ALT, AST and health complications ( P<0.05), but the indexes of creatinine were worse in the urapidil group. Furthermore, the two methods of treatment were comparable in diastolic blood pressure, left ventricular end-systolic volume, left ventricular end-systolic dimension, heart rate, fasting plasma glucose and total cholesterol levels ( P>0.05).


          Based on the current evidence, urapidil treatment had better clinical safety features than the traditional pharmaceutical treatment with nitroglycerin. For those indicators with a small amount of data, a greater number of randomized, high-quality controlled trials should be conducted in order to further verify the findings, which could give researchers a more comprehensive evaluation of urapidil treatment.

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          Most cited references 31

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          Clinical epidemiology of heart failure: public and private health burden.

          Clinically overt heart failure is common, costly, disabling, and deadly; it remains so despite the tremendous benefit of angiotensin-converting enzyme inhibitors. Better treatments for and earlier detection of heart failure are needed if the situation to improve. However, even this may not be enough. The dramatic deterioration in quality of life and prognosis when a patient progresses from asymptomatic left ventricular dysfunction to overt heart failure suggests that only a programme of screening and prevention will effectively reduce the public health burden of heart failure. Moreover, the economic consequences of developing overt heart failure suggest that such an approach is likely to be cost-effective.
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            • Article: not found

            Acute heart failure: clinical presentation, one-year mortality and prognostic factors.

            Acute heart failure (HF) is a common but ill-defined clinical entity. We describe patients hospitalised with acute HF in regard of clinical presentation, mortality, and risk factors for an unfavourable outcome. We conducted a prospective study including 312 consecutive patients from two European centers hospitalised with acute HF, defined as new onset or worsening of symptoms and signs of HF within 7 days. The mean age was 73 years and 56% were men. Twenty-eight percent had de-novo acute HF and 72% a decompensation of chronic HF. Coronary heart disease (CHD) was the most frequent underlying heart disease, elevated blood pressure >150 mmHg and acute ischemia being the most important triggers. Four percent of the patients had cardiogenic shock, 13% presented with pulmonary edema. LV-EF was 50% in 35%, 32% and 33% of the patients, respectively. ICU-treatment was necessary in 39% of the patients. Thirty-day mortality (11%) was increased in the presence of shock or elevated troponin T levels. Twelve-month all-cause mortality (29%) increased in the presence of shock, left ventricular dysfunction, renal insufficiency, CHD, and age. This prospective study shows that despite modern treatment, morbidity and mortality of patients hospitalised with acute HF remain high.
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              The pathophysiology of hypertensive acute heart failure


                Author and article information

                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                27 December 2018
                : 13
                : 161-172
                [1 ]Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, sqfeng@ 123456tmu.edu.cn ; ningguangzhi@ 123456foxmail.com
                [2 ]Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, sqfeng@ 123456tmu.edu.cn ; ningguangzhi@ 123456foxmail.com
                Author notes
                Correspondence: Shiqing Feng; Guangzhi Ning, Department of Orthopaedics, Tianjin Medical University General Hospital, No 154 Anshan Road, Heping District, Tianjin 300052, PR China, Tel +86 022 8836 6139, Fax +86 022 8836 6139, Email sqfeng@ 123456tmu.edu.cn ; ningguangzhi@ 123456foxmail.com

                These authors contributed equally to this work

                © 2019 Shi et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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