Sodium nitroprusside (SNP) remains one of the most potent intravenous vasodilators in acute cardiovascular care, despite the availability of newer vasoactive therapies. In this PRISMA-guided systematic review, the analysis provides an overview of the pharmacological profile, clinical applications, and safety considerations of SNP in acute heart failure (AHF), cardiogenic shock, hypertensive emergencies, and acute aortic dissection. The study was published in the Vascular Pharmacology.

SNP exerts its effects through nitric oxide–mediated activation of the cyclic guanosine monophosphate (cGMP) pathway, resulting in balanced arterial and venous vasodilation. This leads to preload and afterload reduction and enables prompt blood pressure (BP) control.

Available evidence suggests significant hemodynamic improvement in selected patients with advanced AHF. Observational data indicate possible survival benefits, although definitive conclusions remain limited. In hypertensive crises and acute aortic syndromes, SNP remains an effective option for rapid BP reduction and control of vascular wall stress, consistent with current guideline recommendations.

Safety considerations remain central to SNP use. The risk of cyanide and thiocyanate toxicity, particularly with high-dose or prolonged infusions, limits extended use.
SNP remains a valuable therapeutic tool, while a more individualized approach and well-designed randomized trials are needed to better define its long-term clinical impact in contemporary vascular pharmacotherapy.