50
Resistant Hypertension
Table 16. Intravenous Antihypertensive Drugs for Treatment
of Hypertensive Emergencies in Patients With
Selected Comorbidities
Comorbidity
Preferred
Drug(s)
a
Comments
Acute aortic dissection Esmolol,
labetalol
• Requires rapid lowering of SBP to
≤120 mm Hg.
• Beta blockade should precede vasodilator
(e.g., nicardipine or nitroprusside)
administration, if needed for BP control or
to prevent reflex tachycardia or inotropic
effect.
• SBP ≤120 mm Hg should be achieved
within 20 min.
Acute pulmonary
edema
Clevidipine,
nitroglycerin,
nitroprusside
• Βeta blockers contraindicated.
Acute coronary
syndromes
Esmolol
b
labetalol
nicardipine
nitroglycerin
b
• Nitrates given in the presence of PDE-5
inhibitors may induce profound
hypotension.
• Contraindications to beta blockers
include moderate-to-severe LV failure
with pulmonary edema, bradycardia (<60
bpm), hypotension (SBP <100 mm Hg ),
poor peripheral perfusion, second- or
third-degree heart block, and reactive
airways disease.
Acute renal failure Clevidipine
fenoldopam,
nicardipine
• N/A
Eclampsia or
preeclampsia
Hydralazine,
labetalol,
nicardipine
• Requires rapid BP lowering.
• ACE inhibitors, ARBs, renin inhibitors,
and nitroprusside contraindicated.
Perioperative
hypertension (BP
≥160/90 mm Hg or
SBP elevation ≥20%
of the preoperative
value that persists for
>15 min)
Clevidipine
esmolol,
nicardipine,
nitroglycerin
• Intraoperative hypertension is most
frequently seen during anesthesia
induction and airway manipulation.
