Table 15.
Preferred drugs for selected hypertensive emergencies
| Emergency | Drugs of choice | Target blood pressure |
|---|---|---|
| Cerebrovascular situations | ||
| Hypertensive encephalopathy (manifestations of cerebral edema) | -Labetalol-Esmolol-Nitroprusside (only if necessary) | 20-25% in 2-3 hours |
| Subarachnoid hemorrhage | -Nimodipine-Labetalol | 20-25% in 2-3 hours |
| Ischemic stroke | -Nimodipine-Labetalol | 10–15% in the first 24 hours |
| Cardiac situations | ||
| Aortic dissection | -Nitroprusside + beta blockers (esmolol, labetalol) | 100-110 mmHg SBP as soon as possible |
| Acute coronary syndrome | -Beta blocker-Nitroglycerin | Secondary to ischemia relief |
| Pulmonary edema with systolic dysfunction | -Nitroglycerin + loop diuretic | Improve symptoms 10-15% in 1-2 hours |
| Pulmonary edema with diastolic dysfunction | -Beta blockers (esmolol, metoprolol, labetalol) + low-dosenitroglycerin + loop diuretic | |
| Renal situations | ||
| Hypertensive emergency with acute or chronic renal failure | -Labetalol-Nitroprusside (with caution) | Target BP 20-25% in 2-3 hours |
| Other situations | ||
| Catecholamine excess (sympathetic crisis/cocaine overdose) | -Labetalol-Verapamil, diltiazem, or nicardipine in combination with abenzodiazepine | Control paroxysms 10-15% in 1-2 hours |
| Eclampsia | -Hydralazine-Labetalol(all in conjunction with magnesium sulfate) | |
| Postoperative hypertension | -Esmolol-Labetalol | |
| Withdrawal of antihypertensive treatment | -Reinstitution of clonidine or beta blockers-Nitroprusside + IV propranolol or labetalol |