80
Complications of Management
Table 26. Intravenous Antihypertensive Drugs for Treatment
of Hypertensive Emergencies
Class Drug(s) Usual Dose Range
CCB—
dihydropyridines
Nicardipine Initial 5 mg/h, increasing every 5 min by 2.5 mg/h
to maximum 15 mg/h
Clevidipine Initial 1–2 mg/h, doubling every 90 s until BP
approaches target, then increasing by less than
double every 5–10 min; maximum dose 21 mg/h;
maximum duration 72 h
Vasodilators
Nitric-oxide
dependent
Sodium
nitroprusside
Initial 0.3–0.5 mcg/kg/min; increase in increments
of 0.5 mcg/kg/min q 5 min to achieve BP target;
maximum dose 10 mcg/kg/min; duration of
treatment as short as possible
Nitroglycerin Initial 5 mcg/min; increase in increments of 5 mcg/min
every 3–5 min to a maximum rate of 200 mcg/min
Vasodilators
Direct
Hydralazine Initial 10 mg via slow IV infusion (maximum initial
dose 20 mg ); repeat every 4–6 h as needed. Adjust
rate up to total cumulative dose of 200 mg/24 hours.
Adrenergic
blockers
Beta-1 receptor
selective
antagonist
Esmolol Loading dose 500–1000 mcg/kg/min over 1
min followed by a 50-mcg/kg/min infusion. For
additional dosing, the bolus dose is repeated, and the
infusion increased in 50-mcg/kg/min increments as
needed to a maximum of 300 mcg/kg/min.
6.2.1. Medications for Hypertensive Emergencies
