The Cause of Hypertensive Pulmonary Edema

Patients with acute pulmonary edema and marked hypertension often are found to have normal left ventricular function after their clinical status has improved and the hypertension has resolved. In such cases, pulmonary edema may have resulted from isolated diastolic dysfunction, transient systolic dysfunction, or acute mitral regurgitation. To identify the causative factors, these authors used echocardiography to assess ventricular function during the acute episode and 24 to 72 hours later, after the acute episode had resolved.

In the 38 patients evaluated, mean systolic blood pressure decreased from 200+/-26 mm Hg initially to 139+/-17 mm Hg at follow-up. Acute pulmonary edema was treated with furosemide in all patients and nitroglycerine in…