85
Table 27. Intravenous Antihypertensive Drugs for Treatment
of Hypertensive Emergencies in Patients With
Selected Comorbidities
Comorbidity Preferred Drug(s)* Comments
Acute ICH Clevidipine,
nicardipine, esmolol,
labetalol, hydralazine
Section 5.3.9.1
Acute ischemic stroke Clevidipine,
nicardipine, esmolol,
labetalol, hydralazine
Section 5.3.9.2
* Agents are listed in alphabetical order, not in order of preference.
†
Agent of choice for acute coronary syndromes.
ACE indicates angiotensin-converting enzyme; bpm, beats per minute; LV, le ventricular; and
PDE-5, phosphodiesterase type-5.
Modified with permission from Whelton et al. Copyright © 2018 American College of
Cardiolog y Foundation and American Heart Association, Inc.
6.4. Patients Scheduled for Surgical Procedures
COR LOE
Recommendations
1 B-NR
1. In patients with hypertension scheduled for major surgery
who have been on BB chronically, BB should be continued
throughout the perioperative period to assist with BP control.
2a C-EO
2. In patients with hypertension scheduled for elective major
surgery, it is reasonable to continue most medications for
hypertension throughout the perioperative period.
2b B-R
3. In patients with hypertension scheduled for major surgery,
discontinuation of ACEi or ARB preoperatively may be
considered to prevent hypotension during surgery.
2b C-LD
4. In patients scheduled for elective major surgery with SBP
≥180 mm Hg or DBP ≥110 mm Hg, deferring surgery may
be considered especially in high-risk patients to minimize
perioperative complications.
3: Harm B-NR
5. In patients with hypertension scheduled for surgery, abrupt
preoperative discontinuation of BB or clonidine may result in
rebound hypertension and is potentially harmful.
3: Harm B-R
6. For patients with hypertension scheduled for surgery, BB
should not be started on the day of surgery in BB-naïve
patients because of increased risk of postoperative mortality.
(cont'd)
