Sodium Nitroprusside Safe and Effective for Advanced Heart Failure Patients, Study Finds

"Our findings emphasize the potential of nitroprusside to enhance systemic and renal perfusion in these advanced patients," the researchers wrote.

Heart failure, particularly in its advanced stages, presents numerous challenges for both patients and healthcare providers, especially when mechanical circulatory support or transplant options are not available, underscoring a gap in evidence-based medical management. Traditional treatments often fall short of addressing severe symptoms and improving outcomes. Sodium nitroprusside, a potent vasodilator, has been under investigation for its potential to enhance systemic and renal perfusion in these critically ill patients.

Against the above background, Stefano Ghio, Division of Cardiology, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy, and colleagues aimed to evaluate the effectiveness and safety of SNP for enhancing systemic and renal perfusion in patients with AdvHF, with or without concomitant inotropic support.

For this purpose, the researchers retrospectively examined the medical records of 406 patients with advanced heart failure (AdvHF) admitted between October 2014 and September 2018 who received nocturnal sodium nitroprusside (SNP) infusions for at least one week. In 55 patients who exhibited symptomatic hypotension or signs of peripheral hypoperfusion (differential systemic blood pressure < 15 mmHg), continuous dobutamine infusion was added. Additionally, for a subset of 155 patients who required multiple hospitalizations (median of 3), data from their most recent hospitalization were analyzed.

The following were the key findings of the study:

• No symptomatic hypotension leading to discontinuation of SNP (mean dose: 0.5 ± 0.1 μg/kg/min) was reported.
• Patients showed a significant increase in differential systemic blood pressure after infusion (29.2 ± 8.1 to 36.8 ± 11.6 mmHg) independent of dobutamine use.
• Administration of SNP and dobutamine resulted in greater weight loss than SNP alone (−5.33 ± 7.02 versus −3.32 ± 4.0 kg). However, it was also associated with a significant increase in creatinine levels compared to SNP alone (+0.24 ± 0.87 versus +0.02 ± 0.43).

"Sodium nitroprusside therapy is a safe and effective treatment option for patients with advanced heart failure (AdvHF). SNP can enhance systemic perfusion and, when used without inotropic support, may help prevent worsening renal function during hospitalization," the researchers wrote.

"These findings underscore the need for further investigation into SNP therapy through randomized clinical trials to fully explore its benefits in AdvHF. SNP can be administered safely either alone or in combination with dobutamine for patients showing signs of systemic hypoperfusion," they concluded.

Reference:

Ghio, S., Traversi, E., Maestri, R., Camporotondo, R., Caporotondi, A., Caprino, A., Fasolino, A., Guazzotti, G., Scelsi, L., Turco, A., & La Rovere, M. T. (2024). Sodium nitroprusside infusion in patients with advanced heart failure. Vascular Pharmacology, 156, 107395. https://doi.org/10.1016/j.vph.2024.107395