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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)

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