Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society for Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group.

Sean P. Collins
Phillip D. Levy
Jennifer L. Martindale
Mark E. Dunlap
Alan B. Storrow
Peter S. Pang
Nancy M. Albert
G Michael Felker
Gregory J. Fermann
Gregg C. Fonarow
Michael M. Givertz, Maine Medical Center
Judd E. Hollander
David E. Lanfear
Daniel J. Lenihan
JoAnn M. Lindenfeld
W Frank Peacock
Douglas B. Sawyer, Maine Medical Center
John R. Teerlink
Javed Butler
Brian C. Hiestand


Management approaches for patients in the emergency department ( ED) who present with acute heart failure ( AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H- AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease that is based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H- AHF.