Table 5. Treatment of acute hypertension (BP > 160/110 mm Hg).

1. Position the patient in left lateral decubitus.

2. Infuse 5% glucose serum into the peripheral vein.

3. Administer nifedipine 10 mg orally and repeat 10 mg every 30 minutes if necessary.

If there is no adequate response, administer IV hydralazine 5 mg.* If BP is not controlled, repeat 5–10 mg every 20 minutes.

4. Check maternal BP every 5 minutes for 20 minutes after medication administration.

5. Evaluate fetal cardiac frequency (cardiotocography) for at least 20 minutes after medication administration.

6. Repeat medication if necessary (BP > 155/105 mm Hg), up to the maximum dose of 30 mg for each drug.

7. Maintain BP < 160/110 mm Hg and > 135/85 mm Hg.

8. Other options:

A. Labetalol 20 mg IV bolus and, if necessary, repeat 40 mg in 10 minutes, and up to two doses of 80 mg every 10 minutes up to a maximum dose of 220 mg. Do not use in asthmatics patients or in those with heart failure.

B. Sodium nitrate 0.25 μg (kg/min) up to maximum of 4 μg (kg/min) and do not use for more than 4 hours.

Abbreviations: BP, blood pressure; IV, intravenous.

Note: *Dilute 1 ampoule (20 mg 2 mL) in 3 mL of distilled water: each milliliter will have 5 mg of hydralazine.

Adapted from: Report of the National High Blood Pressure Education Program (2000).15