Oral and Intravenous Antihypertensive Medications for Acute Severe HTN
| Useful for Severely Hypertensive Patients With Life-Threatening Symptoms . | ||||
|---|---|---|---|---|
| Drug . | Class . | Dose . | Route . | Comments . |
| Esmolol | β-adrenergic blocker | 100–500 mcg/kg per min | Intravenous infusion | Short acting, constant infusion preferred. May cause profound bradycardia |
| Hydralazine | Direct vasodilator | 0.1–0.2 mg/kg per dose up to 0.4 mg/kg per dose | Intravenous, intramuscular | Causes tachycardia |
| Give every 4 h when given intravenous bolus | ||||
| Labetalol | α- and β-adrenergic blocker | Bolus: 0.20–1.0 mg/kg per dose up to 40 mg per dose | Intravenous bolus or infusion | Asthma and overt heart failure are relative contraindications |
| Infusion: 0.25–3.0 mg/kg per h | ||||
| Nicardipine | Calcium channel blocker | Bolus: 30 mcg/kg up to 2 mg per dose | Intravenous bolus or infusion | May cause reflex tachycardia. Increases cyclosporine and tacrolimus levels |
| Infusion: 0.5–4 mcg/kg per min | ||||
| Sodium nitroprusside | Direct vasodilator | Starting: 0–3 mcg/kg per min | Intravenous infusion | Monitor cyanide levels with prolonged (>72 h) use or in renal failure; or coadminister with sodium thiosulfate |
| Maximum: 10 mcg/kg per min | ||||
| Useful for Severely Hypertensive Patients With Less Significant Symptoms | ||||
| Clonidine | Central α-agonist | 2–5 mcg/kg per dose up to 10 mcg/kg per dose given every 6–8 h | Oral | Adverse effects include dry mouth and drowsiness |
| Fenoldopam | Dopamine receptor agonist | 0.2–0.5 mcg/kg per min up to 0.8 mcg/kg per min | Intravenous infusion | Higher doses worsen tachycardia without further reducing BP |
| Hydralazine | Direct vasodilator | 0.25 mg/kg per dose up to 25 mg per dose given every 6–8 h | Oral | Half-life varies with genetically determined acetylation rates |
| Isradipine | Calcium channel blocker | 0.05–0.1 mg/kg per dose up to 5 mg per dose given every 6–8 h | Oral | Exaggerated decrease in BP can be seen in patients receiving azole antifungal agents |
| Minoxidil | Direct vasodilator | 0.1–0.2 mg/kg per dose up to 10 mg per dose given Q 8–12 h | Oral | Most potent oral vasodilator, long acting |
| Useful for Severely Hypertensive Patients With Life-Threatening Symptoms . | ||||
|---|---|---|---|---|
| Drug . | Class . | Dose . | Route . | Comments . |
| Esmolol | β-adrenergic blocker | 100–500 mcg/kg per min | Intravenous infusion | Short acting, constant infusion preferred. May cause profound bradycardia |
| Hydralazine | Direct vasodilator | 0.1–0.2 mg/kg per dose up to 0.4 mg/kg per dose | Intravenous, intramuscular | Causes tachycardia |
| Give every 4 h when given intravenous bolus | ||||
| Labetalol | α- and β-adrenergic blocker | Bolus: 0.20–1.0 mg/kg per dose up to 40 mg per dose | Intravenous bolus or infusion | Asthma and overt heart failure are relative contraindications |
| Infusion: 0.25–3.0 mg/kg per h | ||||
| Nicardipine | Calcium channel blocker | Bolus: 30 mcg/kg up to 2 mg per dose | Intravenous bolus or infusion | May cause reflex tachycardia. Increases cyclosporine and tacrolimus levels |
| Infusion: 0.5–4 mcg/kg per min | ||||
| Sodium nitroprusside | Direct vasodilator | Starting: 0–3 mcg/kg per min | Intravenous infusion | Monitor cyanide levels with prolonged (>72 h) use or in renal failure; or coadminister with sodium thiosulfate |
| Maximum: 10 mcg/kg per min | ||||
| Useful for Severely Hypertensive Patients With Less Significant Symptoms | ||||
| Clonidine | Central α-agonist | 2–5 mcg/kg per dose up to 10 mcg/kg per dose given every 6–8 h | Oral | Adverse effects include dry mouth and drowsiness |
| Fenoldopam | Dopamine receptor agonist | 0.2–0.5 mcg/kg per min up to 0.8 mcg/kg per min | Intravenous infusion | Higher doses worsen tachycardia without further reducing BP |
| Hydralazine | Direct vasodilator | 0.25 mg/kg per dose up to 25 mg per dose given every 6–8 h | Oral | Half-life varies with genetically determined acetylation rates |
| Isradipine | Calcium channel blocker | 0.05–0.1 mg/kg per dose up to 5 mg per dose given every 6–8 h | Oral | Exaggerated decrease in BP can be seen in patients receiving azole antifungal agents |
| Minoxidil | Direct vasodilator | 0.1–0.2 mg/kg per dose up to 10 mg per dose given Q 8–12 h | Oral | Most potent oral vasodilator, long acting |