Hypertensive emergencies are characterized by acute marked elevations in blood pressure associated with end organ damage and require an immediate reduction in blood pressure to prevent further damage [1]. In comparison, hypertensive urgencies are characterized by acute marked elevations in blood pressure without end organ damage and do not require a prompt decrease in blood pressure. Collectively, hypertensive urgency and emergency episodes are referred to as hypertensive crises. In the management of hypertensive emergencies, the initial blood pressure goal and choice of antihypertensive are determined by the organ affected and patient comorbidities [2].

Nitroglycerin remains the standard of therapy in the management of acute heart failure with hypertension (AHF-H) despite a lack of data demonstrating improved outcomes in hospitalized patients with its use [3,4]. In the management of AHF-H nitroglycerin may prevent or alleviate pulmonary congestion through reducing preload and afterload at low and high doses, respectively [3]. However, its effects are not always observed due to the development of tachyphylaxis in patients on chronic nitrate therapy or those receiving prolonged infusion durations [3].

Nicardipine, a dihydropyridine calcium channel blocker (CCB), is also commonly used in the management of hypertensive crises, except those involving cardiac contractility defects despite its ability to reduce afterload and pulmonary congestion [1,2]. Dihydropyridine CCBs are possibly infrequently used in patients with reduced ejection fractions due to concerns they may reduce contractility and cardiac output. However, in comparison to non-dihydropyridine CCBs (i.e. diltiazem, verapamil), dihydropyridine CCBs display greater selectivity for calcium channels in vascular smooth muscle cells and minimal to no myocardial depressant activity [5,6]. Despite these pharmacological differences, literature to date evaluating the use of nicardipine in this population is limited and it remains unknown if nicardipine can be used for this indication. The purpose of this study was to evaluate the efficacy and safety of nicardipine in adults with reduced ejection fractions presenting with AHF-H.