IV Antihypertensives
| Type | Duration | Meds |
|---|---|---|
| Titratable Agents | <30min | Esmolol, Clevidipine, Nitroglycerin, Nitroprusside |
| Semi-titratable agents | <1-2hrs | Nicardipine, Diltiazem |
| Bolus Agents | >1-2hrs | Labetolol, Metoprolol, Hydralazine |
| Pathology | Ideal Antihypertensive (Primary/Secondary/Adjuncts) | BP Goal |
|---|---|---|
| Aortic Dissection | Esmolol / diltiazem / nicardipine/clevidipine | SBP <100-120 |
| PRES | Clevidipine / Nicardipine | ~160/100 |
| Subarachnoid Hemorrhage | Nicardipine / Enalapril / oral nimodipine | SBP <160 |
| Non-traumatic ICH | nicardipine / esmolol | SBP ~140 |
| SCAPE | nitroglycerin | |
| Ischemic Stroke | clevidipine / nicardipine | <180/105 (thrombolysis) <220/110 (permissive HTN) |
| ACS | nitroglycerin / nicardipine / clevidipine | Symptom Relief |
| Pregnancy-related | hydralazine / labetolol / ALWAYS magnesium | <140/90 |
Simplified Summary
- When in doubt, choose CCB (Clevidipine / Nicardipine)
- ACS / SCAPE = nitroglycerin / CCB
- Aortic Dissection = esmolol / CCB
Oral Antihypertensives
In Emergency Department:
- Continuing home antihypertensives for admitted patient
- Reasonable to initiate HTN meds if good outpatient follow up