84
Complications of Management
Table 27. Intravenous Antihypertensive Drugs for Treatment
of Hypertensive Emergencies in Patients With
Selected Comorbidities
Comorbidity Preferred Drug(s)* Comments
Acute aortic dissection Esmolol, labetalol Requires rapid lowering of SBP to
≤120 mm Hg. Beta blockade should
precede vasodilator (eg, 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
Beta blockers contraindicated.
Acute coronary
syndromes
Esmolol
†
, labetalol,
nicardipine,
nitroglycerin
†
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 kidney injury Clevidipine,
fenoldopam,
nicardipine
N/A
Eclampsia or
preeclampsia
Hydralazine,
labetalol, nicardipine,
nifedipine
Requires rapid BP lowering. ACE
inhibitors, ARB, 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.
Acute sympathetic
discharge or
catecholamine
excess states (eg,
pheochromocytoma,
postcarotid
endarterectomy status)
Clevidipine,
nicardipine,
phentolamine
Requires rapid lowering of BP.
