Fast Five Quiz: Review Key Information on Hypertensive Emergencies

Richard H. Sinert, DO


January 02, 2018

The preferred medications in patients with preeclampsia or eclampsia include labetalol and nifedipine. Avoid nitroprusside, angiotensin-converting enzyme inhibitors, and esmolol. In women with eclampsia or preeclampsia, the systolic BP should be < 160 mm Hg and the diastolic BP should be < 110 mm Hg in the antepartum and intrapartum periods. If the platelet count is less than 100,000 cells/mm3, the BP should be maintained < 150/100 mm Hg. Patients with eclampsia or preeclampsia should also be treated with intravenous magnesium sulfate to avoid seizures.

Alpha-adrenergic antagonists (phentolamine) are the preferred agents for cocaine-associated acute coronary syndromes. Pheochromocytoma treatment guidelines are similar to that of cocaine toxicity. Only after alpha blockade can beta-blockers be added for BP control.

For acute intracerebral hemorrhage, the preferred medications are labetalol, nicardipine, and esmolol; avoid nitroprusside and hydralazine. The treatment is based on clinical/radiographic evidence of increased intracranial pressure.

In aortic dissection, the preferred medications are labetalol, nicardipine, nitroprusside (with beta-blocker), esmolol, and morphine sulfate. However, avoid beta-blockers if aortic valvular regurgitation or suspected cardiac tamponade is present.

For more on the treatment of neurologic and cardiac emergencies in patients with hypertensive emergencies, read here.


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