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C HAPTER 35 / Hypertension 815

Table 35-8 ■ PARENTERAL DRUGS FOR TREATMENT OF HYPERTENSIVE EMERGENCIES*
Onset of Duration of
Dose Action Action Drug Adverse Effects † Special Indications

Vasodilators
Sodium nitroprusside 0.25–10 g/kg/min Immediate 1–2 minutes Nausea, vomiting, muscle Most hypertensive emergencies;
as IV infusion † twitching, sweating, caution with high intracranial
(maximal dose for thiocyanate and pressure or azotemia
10 minutes only) cyanide intoxication
Nicardipine hydrochloride 5–15 mg/h IV 5–10 minutes 1–4 hour Tachycardia, headache, Most hypertensive emergencies
flushing, local phlebitis except acute heart failure;
caution with coronary
ischemia
Fenoldopam mesylate 0.1–0.3 g/kg/min 5 minutes 30 minutes Tachycardia, headache, Most hypertensive emergencies;
IV infusion nausea, flushing caution with glaucoma
Nitroglycerin 5–100 g/min as 2–5 minutes 3–5 minutes Headache, vomiting, Coronary ischemia
IV infusion ‡ methemoglobinemia,
tolerance with
prolonged use
Enalaprilat 1.25–5 mg every 15–30 minutes 6 hours Precipitous fall in pressure Acute left ventricular failure;
6 hours IV in high renin states; avoid in acute myocardial
response variable infarction
Hydralazine hydrochloride 10–20 mg IV 10–20 minutes 3–8 hours Tachycardia, flushing, Eclampsia
10–50 mg IM 20–30 minutes headache, vomiting,
aggravation of angina
Diazoxide 50–100 mg IV bolus 2–4 minutes 6–12 hours Nausea, flushing, Now obsolete; when no
repeated, or tachycardia, chest pain intensive monitoring
15–30 mg/min available
infusion
Adrenergic Inhibitors
Labetalol hydrochloride 20–80 mg IV bolus 5–10 minutes 3–6 hours Vomiting, scalp tingling, Most hypertensive emergencies
every 10 minutes burning in throat, except acute heart failure
0.5–2.0 mg/min dizziness, nausea, heart
IV infusion block, orthostatic
hypotension
Esmolol hydrochloride 250–500 g/kg/min 1–2 minutes 10–20 minutes Hypotension, nausea Aortic dissection, perioperative
for 1 minute, then
50–100 g/kg/min
for 4 minutes; may
repeat sequence
Phentolamine mesylate 5–15 mg IV 1–2 minutes 3–10 minutes Tachycardia, flushing, Catecholamine excess
headache

* These doses may vary from those in the Physicians’ Desk Reference (51st edition).
† Hypotension may occur with all agents.
‡ Require special delivery system.
IV, intravenous; IM, intramuscular.
From Chobanian, A. V., Bakris, G. L., Black, H. R., et al. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure: The JNC 7 report. JAMA, 289(19), 2560–2572. (Erratum in JAMA, 2003, 290(2), 197.)

and control remain low (see Table 35-3). This lack of success in take a partnership role in treatment, and (5) resolve barriers to BP
managing HTN has many contributing factors. 205,221–224 Achiev- control. Chapters 44 and 46 include a review of strategies that
ing HTN control requires concerted action by patients, providers, have been demonstrated to be effective in helping patients control
and health care organizations. Table 35-9 summarizes strategies to their risk factors for CVD.
promote HTN control.
Role of Health Care Providers
Role of Patients Health care providers in partnership with patients hold the keys
The challenge for patients in achieving HTN control is to mod- to HTN control. The following is required of providers: (1) iden-
ify their lives in ways that support their treatment plan. Making tify, prevent, and correctly treat HTN, (2) promote public and
the decision to control one’s HTN is the critical factor that pre- community awareness of HTN, (3) develop communication skills
cedes lifestyle modification and HTN control. 225 Bakris et al. 226 that empower patients, and (4) advocate improved access to
recently identified key action steps required by each of these HTN health care. 226 The provider’s responsibilities range from knowing
care constituents to substantially improve BP control rates. Pa- and using the latest guidelines for HTN control to motivating the
tients must take the following actions: (1) take an active and patient to follow the treatment plan. At a minimum, the challenges
responsible role in personal health management, (2) be appropri- to a provider include correctly diagnosing the patient’s condition;
ately educated, (3) develop skills to monitor and control BP, (4) communicating the importance of HTN as a disease and as a risk