Hypertension, Malignant/Management and Treatment

Common intravenous (IV) medications and doses used to treat hypertensive emergencies

Nicardipine, initial infusion rate 5 mg per hour, increasing by 2.5 mg per hour every 5 minutes to a maximum of 15 mg per hour

or
Sodium nitroprusside, 0.3 to 0.5 mcg/kg/minute, increases by 0.5 mcg/kg per minute every few minutes as needed to a maximum dose of 10 mcg/kg per minute.

or
Labetalol 10 to 20 mg IV followed by bolus doses of 20 to 80 mg at 10-minute intervals until a target blood pressure is reached to a maximum 300-mg cumulative dose

or
Esmolol, initial loading dose 500 mcg/kg/minute over 1 minute, then 50 to 100 mcg/kg/minute to a maximum dose of 300 mcg/kg per minute.


If there is any possibility of over or underestimating BP using frequent noninvasive cuff measurements or if the end-organ damage is life-threatening, consider arterial catheterization for precise, second-to-second measurements allowing for more careful medication titration.

> 02. Major exceptions to gradual BP lowering over the first day

 

Hypertension, Malignant

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