Evaluation of the blood pressure effects of diltiazem versus metoprolol in the acute treatment of atrial fibrillation with rapid ventricular rate

Purpose: To evaluate the difference in blood pressure effects of diltiazem intravenous push (IVP) and metoprolol IVP in the acute management of atrial fibrillation with rapid ventricular rate (AF with RVR). Methods: This was a single-center, retrospective cohort study evaluating patients who presented to the emergency department (ED) between January 2012 and September 2018 in AF with RVR and received either diltiazem IVP or metoprolol IVP as the first agent for rate control. The primary objective was the change in systolic blood pressure (SBP) within one hour of initial medication administration. Secondary outcomes included repeat doses within one hour, rate control to <110 beats per minute, and SBP <90 mmHg or decrease by >40% within three hours. Subgroup analysis of patients with a baseline SBP <110 mmHg was conducted. Results: Of the 160 patients included, 80 received diltiazem and 80 metoprolol. The primary outcome of median change in SBP at one hour was a difference of −9 [−21 to 6] mmHg in the diltiazem group versus a difference of −4 [−18 to 9] mmHg in the metoprolol group (p = 0.102). Subgroup analysis (n = 28) of patients with a baseline SBP <110 mmHg demonstrated an increase of 7 [−0.25 to 19] mmHg in the diltiazem group versus increase of 7 [0 to 13] in the metoprolol group (p = 0.910). Conclusion: No significant difference was observed in the blood pressure effects of diltiazem IVP versus metoprolol IVP in the acute management of AF with RVR.