Pulmonary Oedema

Patients presenting with left ventricular failure and pulmonary oedema often have some degree of elevated BP.

What is the cause of this elevated BP?

Elevated BP is a consequence of chronically increased peripheral vascular resistance and activation of the renin-aldosterone system.
A minority of patients will have a marked acute elevation of BP which has precipitated acute left ventricular failure. Expedient control of BP is indicated in these patients to allow normal functioning of the left ventricle. The drugs used to treat pulmonary oedema will all encourage a fall in BP (i.e. intravenous opiates, intravenous nitrates and intravenous diuretics).
These interventions may be adequate to gain control of the BP. However, if further reduction is required, intravenous nitroprusside can be used since it reduces preload and afterload on the failing heart.

Learning Bite

Standard treatments for pulmonary oedema will reduce elevated BP.