Hypertensive Emergencies |
Nicardipine (Cardene) | Calcium channel blocker | 5 mg/h intravenously; may increase by 1–2.5 mg/h every 15 minutes to 15 mg/h | 1–5 minutes | 3–6 hours | Hypotension, tachycardia, headache. | May precipitate myocardial ischemia. |
Clevidipine (Cleviprex) | Calcium channel blocker | 1–2 mg/h intravenously initially; double rate every 90 seconds until near goal, then by smaller amounts every 5–10 minutes to a maximum of 32 mg/h | 2–4 minutes | 5–15 minutes | Headache, nausea, vomiting. | Lipid emulsion: contraindicated in patients with allergy to soy or egg. |
Labetalol (Trandate) | Beta- and alpha-blocker | 20–40 mg intravenously every 10 minutes to 300 mg; 2 mg/min infusion | 5–10 minutes | 3–6 hours | Nausea, hypotension, bronchospasm, bradycardia, heart block. | Avoid in acute LV systolic dysfunction, asthma. May be continued orally. |
Esmolol (Brevibloc) | Beta-blocker | Loading dose 500 mcg/kg intravenously over 1 minute; maintenance, 25–200 mcg/kg/min | 1–2 minutes | 10–30 minutes | Bradycardia, nausea. | Avoid in acute LV systolic dysfunction, asthma. Weak antihypertensive. |
Fenoldopam (Corlopam) | Dopamine receptor agonist | 0.1–1.6 mcg/kg/min intravenously | 4–5 minutes | < 10 minutes | Reflex tachycardia, hypotension, increased intraocular pressure. | May protect kidney function. |
Enalaprilat (Vasotec) | ACE inhibitor | 1.25 mg intravenously every 6 hours | 15 minutes | 6 hours or more | Excessive hypotension. | Additive with diuretics; may be continued orally. |
Furosemide (Lasix) | Diuretic | 10–80 mg orally or intravenously | 15 minutes | 4 hours | Hypokalemia, hypotension. | Adjunct to vasodilator. |
Hydralazine (Apresoline) | Vasodilator | 5–20 mg intravenously; may repeat after 20 minutes | 10–30 minutes | 2–6 hours | Tachycardia, headache, vomiting, diarrhea | Avoid in coronary artery disease, dissection. Rarely used except in pregnancy. |
Nitroglycerin | Vasodilator | 0.25–5 mcg/kg/min intravenously | 2–5 minutes | 3–5 minutes | Headache, nausea, hypotension, bradycardia. | Tolerance may develop. Useful primarily with myocardial ischemia. |
Nitroprusside (Nitropress) | Vasodilator | 0.25–10 mcg/kg/min intravenously | Seconds | 3–5 minutes | Anxiety, increased intracranial pressure, vomiting, bowel obstruction; thiocyanate and cyanide toxicity, especially with kidney and liver dysfunction; hypotension. Coronary steal, decreased cerebral blood flow, increased intracranial pressure. | No longer the first-line agent. |
Hypertensive Urgencies |
Clonidine (Catapres) | Central sympatholytic | 0.1–0.2 mg orally initially; then 0.1 mg every hour to 0.8 mg orally | 30–60 minutes | 6–8 hours | Sedation. | Rebound may occur. |
Captopril (Capoten) | ACE inhibitor | 12.5–25 mg orally | 15–30 minutes | 4–6 hours | Excessive hypotension. | |
Nifedipine (Adalat, Procardia) | Calcium channel blocker | 10 mg orally initially; may be repeated after 30 minutes | 15 minutes | 2–6 hours | Excessive hypotension, tachycardia, headache, angina, myocardial infarction, stroke. | Response unpredictable. |