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The Diagnosis and Management of Hypertensive Crises*
*+ ,o)ep$ Va"on- MD- FCCP an# .+ Pa(/ E+ Ma"ik- MD- FCCP 0A(t$o" A11i/iation) 0A(t$o" A11i/iation) 1.
*

From the Department of Medicine (Dr. Varon), Baylor College of Medicine, Hou ton !"# and the Department of $nternal Medicine, %ection of Critical Care (Dr. Mari&), 'a hington Ho pital Center, 'a hington, DC.

Ne2t Section

Abstract

Se%e"e $ pe"ten)ion i) a common c/inica/ p"o3/em in t$e Unite# State)- enco(nte"e# in %a"io() c/inica/ )etting)+ A/t$o(g$ %a"io() te"m) $a%e 3een app/ie# to )e%e"e $ pe"ten)ion)(c$ a) $ pe"ten)i%e c"i)e)- eme"gencie)- o" ("gencie)- t$e a"e a// c$a"acte"i4e# 3 ac(te e/e%ation) in BP t$at ma 3e a))ociate# !it$ en#5o"gan #amage 6$ pe"ten)i%e c"i)i)7+ T$e imme#iate "e#(ction o1 BP i) on/ "e8(i"e# in patient) !it$ ac(te en#5o"gan #amage+ H pe"ten)ion a))ociate# !it$ ce"e3"a/ in1a"ction o" int"ace"e3"a/ $emo""$age on/ "a"e/ "e8(i"e) t"eatment+ 9$i/e nit"op"())i#e i) common/ ()e# to t"eat )e%e"e $ pe"ten)ion- it i) an e2t"eme/ to2ic #"(g t$at )$o(/# on/ 3e ()e# in "a"e ci"c(m)tance)+ F("t$e"mo"e- t$e )$o"t5acting ca/ci(m c$anne/ 3/ocke" ni1e#ipine i) a))ociate# !it$ )igni1icant mo"3i#it an# )$o(/# 3e a%oi#e#+ To#a - a !i#e "ange o1 p$a"maco/ogic a/te"nati%e) a"e a%ai/a3/e to t$e p"actitione" to cont"o/ )e%e"e $ pe"ten)ion+ T$i) a"tic/e "e%ie!) )ome o1 t$e c(""ent concept) an# common mi)conception) in t$e management o1 patient) !it$ ac(te/ e/e%ate# BP+
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ao"tic #i))ection :53/ocke") ca/ci(m c$anne/ 3/ocke") 1eno/#opam $ pe"ten)ion $ pe"ten)i%e c"i)e) $ pe"ten)i%e encep$a/opat$ /a3eta/o/ nica"#ipine nit"op"())i#e p"egnanc

H pe"ten)ion i) a common c/inica/ p"o3/em in t$e Unite# State)- an# p$ )ician) o1 a// t pe) a"e /ike/ to enco(nte" patient) !it$ $ pe"ten)i%e ("gencie) an# eme"gencie)+ A/t$o(g$ %a"io() te"m) $a%e 3een app/ie# to t$e)e con#ition)- t$e a"e a// c$a"acte"i4e# 3 ac(te e/e%ation) in BP+*.;<=>?@ P"ompt 3(t ca"e1(// con)i#e"e# t$e"ap i) nece))a" to /imit mo"3i#it an# mo"ta/it +A*B Un1o"t(nate/ - acce/e"ate# $ pe"ten)ion i) among t$e mo)t mi)(n#e")too# an# mi)manage# o1 Cac(teD me#ica/ p"o3/em) )een in c/inica/ p"actice+ Man p$ )ician) $a%e an ("gent nee# to "api#/ /o!e" an e/e%ate# BP !it$o(t con)i#e"ing t$e pat$op$ )io/ogic p"incip/e) in%o/%e#+ P"e%io() SectionNe2t Section

Definitions
T$e ,oint Nationa/ Committee on P"e%ention- Detection- E%a/(ation- an# T"eatment o1 Hig$ B/oo# P"e))("e $a) c/a))i1ie# $ pe"ten)ion acco"#ing to t$e #eg"ee o1 BP e/e%ation+* Stage * patient) $a%e a ) )to/ic BP o1 *<B to *=A mm Hg o" a #ia)to/ic BP o1 AB to AA mm Hg+ Stage . in#i%i#(a/) $a%e a ) )to/ic BP o1 *>B to *?A mm Hg o" a #ia)to/ic BP o1 *BB to *BA mm Hg- !$e"ea) )tage ; inc/(#e) a ) )to/ic BP p"e))("e E *@B mm Hg o" a #ia)to/ic BP E **B

mm Hg+ Stage ; $ pe"ten)ion $a) a/)o 3een ca//e# )e%e"e $ pe"ten)ion o" acce/e"ate# $ pe"ten)ion+ T$e 1eat("e) an# c/a))i1ication an# o1 p"egnanc 5in#(ce# $ pe"ten)ion a"e inc/(#e# in Ta3/e * +** A n(m3e" o1 #i11e"ent te"m) $a%e 3een app/ie# to )e%e"e ac(te e/e%ation) o1 BP+ Ho!e%e"mo)t a(t$o") $a%e #e1ine# $ pe"ten)i%e c"i)e) o" eme"gencie) a) a )(##en inc"ea)e in ) )to/ic an# #ia)to/ic BP a))ociate# !it$ en#5o"gan #amage o1 t$e CNS- t$e $ea"t- o" t$e ki#ne )F t$e te"m hyperten i(e urgencie $a) 3een ()e# 1o" patient) !it$ )e%e"e/ e/e%ate# BP !it$o(t ac(te en#5o"gan #amage+.;<=@*.*; Ta3/e . /i)t) t$o)e c/inica/ con#ition) t$at meet t$e #iagno)tic c"ite"ia o1 $ pe"ten)i%e c"i)e)+ It i) impo"tant to note t$at t$e c/inica/ #i11e"entiation 3et!een $ pe"ten)i%e eme"gencie) an# $ pe"ten)i%e ("gencie) #epen#) on t$e p"e)ence o1 ta"get o"gan #amage- "at$e" t$an t$e /e%e/ o1 BP+ Anot$e" 1"e8(ent/ enco(nte"e# te"m- malignant hyperten ion- i) #e1ine# a) a ) n#"ome c$a"acte"i4e# 3 e/e%ate# BP accompanie# 3 encep$a/opat$ o" nep$"opat$ +**< Po)tope"ati%e $ pe"ten)ion $a) a"3it"a"i/ 3een #e1ine# a) ) )to/ic BP G *AB mm Hg an#Ho" #ia)to/ic BP E *BB mm Hg on t!o con)ec(ti%e "ea#ing) 1o//o!ing )("ge" +*=*> T$e t"an)ient nat("e o1 po)tope"ati%e $ pe"ten)ion an# t$e (ni8(e c/inica/ 1acto") p"e)ent in t$e po)tope"ati%e pe"io# "e8(i"e t$at t$i) c/inica/ ) n#"ome 3e gi%en in#i%i#(a/ con)i#e"ation+ A ) )to/ic p"e))("e G *>A mm Hg o" a #ia)to/ic G *BA mm Hg in a p"egnant !oman i) con)i#e"e# a $ pe"ten)i%e eme"genc "e8(i"ing imme#iate p$a"maco/ogic management+*? P"e%io() SectionNe2t Section

Epidemiology, Etiology, Pathogenesis
H pe"ten)ion i) e2t"eme/ common in t$e Ame"ican pop(/ation+ Si2t mi//ion US in$a3itant) )(11e" 1"om $ pe"ten)ion+* T$e %a)t maIo"it o1 t$e)e patient) $a%e e))entia/ $ pe"ten)ion+ Mo"eo%e"- a /a"ge n(m3e" o1 a11ecte# in#i%i#(a/) a"e (na!a"e o1 t$ei" $ pe"ten)ion+ T$"ee 8(a"te") o1 t$o)e a11ecte# #o not $a%e t$ei" BP !e// cont"o//e#+ Fe!e" t$an *J o1 t$e)e patient) !i// #e%e/op one o" m(/tip/e epi)o#e) o1 $ pe"ten)i%e c"i)e)+*@*A T$e inci#ence o1 $ pe"ten)i%e c"i)e) i) $ig$e" among A1"ican Ame"ican) an# t$e e/#e"/ +*B*;.B.* T$e maIo"it o1 patient) p"e)enting !it$ $ pe"ten)i%e c"i)e) $a%e p"e%io()/ "ecei%e# a #iagno)i) o1 $ pe"ten)ion- an# man $a%e 3een p"e)c"i3e# anti$ pe"ten)i%e t$e"ap !it$ ina#e8(ate BP cont"o/+*B*;.B T$e inci#ence o1 po)tope"ati%e $ pe"ten)i%e c"i)e) %a"ie) #epen#ing on t$e pop(/ation e2amine#- 3eing "epo"te# in < to ;=J o1 patient) )$o"t/ a1te" t$e )("gica/ p"oce#("e+*>...; Like ot$e" 1o"m) o1 acce/e"ate# $ pe"ten)ion- a $i)to" o1 $ pe"ten)ion i) common+ P"eec/amp)ia 6p"egnanc 5"e/ate# $ pe"ten)ion7 i) a 1o"m o1 $ pe"ten)ion t$at #e)e"%e) mention+ T$e inci#ence o1 p"eec/amp)ia %a"ie) acco"#ing to t$e patient c$a"acte"i)tic)+ It occ(") in ?J o1 a// p"egnancie)+ O1 t$em- ?BJ a"e n(//5g"a%i#a) an# ;BJ a"e m(/ti5g"a%i#a)+ In mo/a" p"egnancie)- p"eec/amp)ia $a) 3een #e)c"i3e# in (p to ?BJ o1 ca)e)+.< T$e pat$op$ )io/og o1 $ pe"ten)i%e c"i)e) i) t$o(g$t to 3e #(e to a3"(pt inc"ea)e) in ) )temic %a)c(/a" "e)i)tance t$at a"e /ike/ "e/ate# to $(mo"a/ %a)ocon)t"icto")+.=.> 9it$ )e%e"e e/e%ation) o1 BP- en#ot$e/ia/ inI(" occ(") an# 1i3"inoi# nec"o)i) o1 t$e a"te"io/e) en)(e)+.=.> T$i) %a)c(/a" inI(" /ea#) to #epo)ition o1 p/ate/et) an# 1i3"in- an# a 3"eak#o!n o1

t$e no"ma/ a(to"eg(/ato" 1(nction+ T$e "e)(/ting i)c$emia p"ompt) 1("t$e" "e/ea)e o1 %a)oacti%e )(3)tance)- comp/eting a %icio() c c/e+.> It )$o(/# 3e app"eciate# t$at mo)t patient) !$o p"e)ent to $o)pita/ !it$ an e/e%ate# BP a"e Cc$"onica// $ pe"ten)i%e-D !it$ a "ig$t!a"# )$i1t o1 t$e p"e))("eH1/o! 6ce"e3"a/ an# "ena/7 a(to"eg(/ation c("%e 6Fig * 7+.? F("t$e"mo"e- mo)t patient) !it$ )e%e"e $ pe"ten)ion 6#ia)to/ic p"e))("e E **B mm Hg7 $a%e no ac(te- en#5o"gan #amage+ Rapi# anti$ pe"ten)i%e t$e"ap in t$i) )etting ma 3e a))ociate# !it$ )igni1icant mo"3i#it +.@.A;B T$e"e a"e- $o!e%e"- t"(e $ pe"ten)i%e eme"gencie) in !$ic$ t$e "api# 6cont"o//e#7 /o!e"ing o1 BP i) in#icate# 6)ee 3e/o!7+*@*A;* P"e%io() SectionNe2t Section

Clinical Manifestations
T$e mani1e)tation) o1 $ pe"ten)i%e c"i)e) a"e t$o)e o1 en#5o"gan # )1(nction+ Ta3/e . /i)t) t$o)e con#ition) t$at- !$en a))ociate# !it$ )e%e"e/ e/e%ate# BP- a"e "e1e""e# to a) $ pe"ten)i%e c"i)e)Heme"gencie)+ O"gan # )1(nction i) (ncommon !it$ #ia)to/ic BP) K *;B mm Hg- a/t$o(g$ it ma occ("+ It i) impo"tant to "ecogni4e t$at t$e a3)o/(te /e%e/ o1 BP ma not 3e a) impo"tant a) t$e "ate o1 inc"ea)e+?A;.;; Fo" e2amp/e- patient) !it$ /ong5)tan#ing $ pe"ten)ion ma to/e"ate ) )to/ic BP) o1 .BB mm Hg o" #ia)to/ic inc"ea)e) (p to *=B mm Hg !it$o(t #e%e/oping $ pe"ten)i%e encep$a/opat$ - !$i/e c$i/#"en o" p"egnant !omen ma #e%e/op encep$a/opat$ !it$ #ia)to/ic BP G *BB mm Hg+*? Hea#ac$e- a/te"e# /e%e/ o1 con)cio()ne))- an# /e))5)e%e"e #eg"ee) o1 CNS # )1(nction a"e t$e c/a))ic mani1e)tation) o1 $ pe"ten)i%e encep$a/opat$ +>? A#%ance# "etinopat$ !it$ a"te"io/a" c$ange)- $emo""$age) an# e2(#ate)- a) !e// a) papi//e#ema- a"e common/ )een on e2amination o1 1(n#i in patient) !it$ $ pe"ten)i%e encep$a/opat$ + Ca"#io%a)c(/a" mani1e)tation) o1 $ pe"ten)i%e c"i)e) ma inc/(#e angina o" ac(te m oca"#ia/ in1a"ction+ Ca"#iac #ecompen)ation ma /ea# to ) mptom) o1 # )pnea- o"t$opnea- co(g$- 1atig(e o" 1"ank p(/mona" e#ema+*B;< Se%e"e inI(" to t$e ki#ne ma /ea# to "ena/ 1ai/("e !it$ o/ig("ia an#Ho" $emat("ia+ In p"egnanc - t$e p"e)entation o1 a patient !it$ p"eec/amp)ia ma "ange 1"om a mi/# to a /i1e5 t$"eatening #i)ea)e p"oce))+ T$e c/inica/ 1eat("e) o1 )e%e"e #i)ea)e inc/(#e %i)(a/ #e1ect))e%e"e $ea#ac$e)- )ei4("e)- a/te"e# con)cio()ne))- ce"e3"o%a)c(/a" acci#ent)- )e%e"e "ig$t (ppe" 8(a#"ant a3#omina/ pain- conge)ti%e $ea"t 1ai/("e- an# o/ig("ia+ T$i) p"oce)) can 3e en#e# on/ 3 #e/i%e" + T$e #eci)ion to contin(e o" to #e/i%e" t$e p"egnanc )$o(/# 3e ma#e 3 con)(/tation 3et!een me#ica/ an# o3)tet"ic pe")onne/+**.<;= One ) n#"ome !a""anting )pecia/ con)i#e"ation i) ac(te ao"tic #i))ection+ P"opagation o1 t$e #i))ection i) #epen#ent not on/ on t$e e/e%ation o1 t$e BP it)e/1- 3(t a/)o on t$e %e/ocit o1 /e1t %ent"ic(/a" eIection+;*;> Fo" t$i) "ea)on- )peci1ic t$e"ap aime# at 3ot$ ta"get) 6BP an# "ate o1 p"e))("e "i)e7 i) (ti/i4e# 1o" t$e)e ca)e) 6)ee 3e/o!7+ P"e%io() SectionNe2t Section

t$i) en# point )$o(/# 3e ac$ie%e# !it$in .()(a// !it$ o"a/ me#ication+ T$e e/e%ate# BP in patient) !it$ $ pe"ten)i%e eme"gencie) )$o(/# 3e t"eate# in a cont"o//e# 1a)$ion in an ICU+ Int"a5a"te"ia/ BP monito"ing i) e))entia/ in a// patient) !it$ $ pe"ten)i%e eme"gencie)+ T$e ()e o1 )(3/ing(a/ ni1e#ipine m()t 3e )t"ong/ con#emne#F t$i) agent ma "e)(/t in a p"ecipito() an# (ncont"o//e# 1a// in BP+ 'i%en t$e )e"io()ne)) o1 t$e "epo"te# a#%e")e e%ent) an# t$e /ack o1 an c/inica/ #oc(mentation atte)ting to a 3ene1it.t$e)e te)t) a"e pe"1o"me# )im(/taneo()/ !it$ t$e initiation o1 anti$ pe"ten)i%e t$e"ap + P"e%io() SectionNe2t Section Therape tic Approach Patient) !it$ $ pe"ten)i%e eme"gencie) "e8(i"e imme#iate cont"o/ o1 t$e BP to te"minate ongoing en#5o"gan #amage.Initial Eval ation of the Patient !ith Hypertensive Crises T$e ke to )(cce))1(/ management o1 patient) !it$ )e%e"e/ e/e%ate# BP i) to #i11e"entiate $ pe"ten)i%e c"i)e) 1"om $ pe"ten)i%e ("gencie)+ T$i) i) accomp/i)$e# 3 a ta"gete# me#ica/ $i)to" an# p$ )ica/ e2amination )(ppo"te# 3 app"op"iate /a3o"ato" e%a/(ation+*A P"io" $ pe"ten)i%e c"i)e).BUN.EC'an# $ea# CT a"e ()e1(/ in patient) !it$ e%i#ence o1 )$o"tne)) o1 3"eat$.B to >B min+..an# BP cont"o/ )$o(/# 3e a)ce"taine#+ Pa"tic(/a" in8(i" )$o(/# inc/(#e t$e ()e o1 monoamine o2i#a)e in$i3ito") an# "ec"eationa/ #"(g) 6ie.*.BP i) /o!e"e# g"a#(a// o%e" a pe"io# o1 .o" ne("o/ogic c$ange).p"o/onge#.p$enc c/i#ine7+ T$e BP in all lim) )$o(/# 3e mea)("e# 3 t$e p$ )ician+ In o3e)e patient).t$i) goa/ )$o(/# 3e ac$ie%e# !it$in = to *B min+ In t$e ot$e" patient).A<B<*<.<=*.IV #"(g t$e"ap i) "e)e"%e# 1o" t$o)e patient) !it$ pe")i)tent ) )to/ic BP) G *@B mm Hg o" pe")i)tent #ia)to/ic BP) G **B mm Hg 6*B= mm Hg in )ome in)tit(tion)7+<? P"io" to #e/i%e" .c"eatinine.cocaine.a c$e)t "a#iog"ap$.it i) #e)i"a3/e to maintain t$e #ia)to/ic BP G AB mm Hg+ T$i) p"e))("e a//o!) 1o" a#e8(ate (te"op/acenta/ pe"1()ion+ I1 #ia)to/ic BP #ec"ea)e) to K AB mm Hg.< to <@ $.anti$ pe"ten)i%e me#ication) p"e)c"i3e#..? T$e imme#iate goa/ o1 IV t$e"ap i) to "e#(ce t$e #ia)to/ic BP 3 *B to *=J.o" to a3o(t **B mm Hg+ In patient) !it$ ac(te ao"tic #i))ection.an# it i) t$e"e1o"e not "ecommence#+ Rapi# an# (ncont"o//e# "e#(ction o1 BP ma "e)(/t in ce"e3"a/.A.#ec"ea)e# (te"op/acenta/ pe"1()ion ma p"ecipitate ac(te 1eta/ #i)t"e)) .<<<=<> Simi/a"/ .B."e)pecti%e/ + An ec$oca"#iog"am )$o(/# 3e o3taine# to a))e)) /e1t %ent"ic(/a" 1(nction an# e%i#ence o1 %ent"ic(/a" $ pe"t"op$ + In man in)tance).an# (ncont"o//e# $ poten)ion.c$e)t pain.t$e patient can 3e )ta"te# on a "egimen o1 o"a/ maintenance t$e"ap + In p"egnanc 5"e/ate# $ pe"ten)ion.)ut not to return B* to normal le(el +.B In patient) !it$ $ pe"ten)i%e ("gencie).an# "ena/ i)c$emiaHin1a"ction+.m oca"#ia/.@.amp$etamine).?.e/ect"o/ te).an# ("ina/ )i) )$o(/# 3e o3taine# in a// patient) p"e)enting !it$ $ pe"ten)i%e c"i)e)+*A A pe"ip$e"a/ 3/oo# )mea" )$o(/# 3e o3taine# to #etect t$e p"e)ence o1 a mic"oangiopat$ic $emo/ tic anemia+ In a##ition.t$e ()e o1 ni1e#ipine cap)(/e) 1o" $ pe"ten)i%e eme"gencie) an# Cp)e(#oeme"gencie)D )$o(/# 3e a3an#one#+.IV $ #"a/a4ine ma "e)(/t in )e%e"e.<.@ Once t$e en# point) o1 t$e"ap $a%e 3een "eac$e#.app"op"iate/ )i4e# c(11) )$o(/# 3e ()e#+ F(n#()copic e2amination i) man#ato" in a// ca)e) to #etect t$e p"e)ence o1 papi//e#ema+ A CBC co(nt.

7+ P"e%io() SectionNe2t Section Antihypertensive Dr gs "sed in Hypertensive Crises #$isted Alphabetically% Clonidine C/oni#ine i) a%ai/a3/e a) an o"a/ an# t"an)#e"ma/ 1o"m(/ation+ O"a/ c/oni#ine 6B+* mg po e%e" .!$ic$ i) a%ai/a3/e in an IV 1o"m(/ation- .B min7 $a) 3een ()e# 1o" t$e t"eatment o1 $ pe"ten)i%e ("gencie)+<@<A T$e on)et o1 action i) !it$in .=<== A) angioten)in II $a) a pat$ogenetic "o/e in t$e #e%e/opment o1 t$e ma/ignant p$a)e o1 $ pe"ten)ion.ena/ap"i/at.an# $a%e a )$o"t $a/15/i1e a"e "ecommen#e# 6Ta3/e .to ma2im(m o1 *=B mg 6)ing/e #o)e7 inIecte# o%e" *B to *= min+*.7 "e8(i"e imme#iate "e#(ction o1 a ma"ke#/ e/e%ate# BP+ In a// ot$e" patient).an# a tota/ #("ation o1 action "anging 1"om .e2cept in e2ceptiona/ ci"c(m)tance) 6)ee 3e/o!7+ Pharmacologic Management A g"o!ing n(m3e" o1 agent) a"e a%ai/a3/e 1o" management o1 $ pe"ten)i%e c"i)e)+ T$e app"op"iate t$e"ape(tic app"oac$ !i// #epen# on t$e c/inica/ p"e)entation o1 t$e patient+ Ho!e%e".an ac(te.t$e e/e%ate# BP can 3e /o!e"e# )/o!/ ()ing o"a/ agent)+ In patient) !$o $a%e )(11e"e# a maIo" ce"e3"o%a)c(/a" e%ent."api# #ec"ea)e in BP ()(a// mean) )(3)tantia/ 3/oo# /o)) an# not a c("e o1 t$e #i)ea)e p"oce))+ It )$o(/# 3e emp$a)i4e# t$at on/ patient) !it$ $ pe"ten)i%e c"i)e)Heme"gencie) 6Ta3/e .> 9$i/e )(3/ing(a/ captop"i/ $a) 3een ()e# in t$e t"eatment o1 $ pe"ten)i%e c"i)e). I1 t$e "e)pon)e i) ina#e8(ate.t$e on)et o1 action i) !it$in * min. mgHkg.compa"ing t$e e11ect) o1 o"a/ ni1e#ipine %) o"a/ c/oni#ine in =* patient).ACE in$i3ito") ma $a%e an impo"tant "o/e in t$e t"eatment o1 t$e)e patient)+.=. to *@ $+=* T$e #o)e o1 a#mini)t"ation o1 #ia4o2i#e i) a mini3o/() o1 * to .#o(3/e53/in# )t(# .a"e ea)i/ tit"ata3/e.=."epeate# #o)e) at *B5 to *=5min inte"%a/) ma 3e gi%en+ Dia4o2i#e $a) )igni1icant )i#e e11ect)+ Sa/t an# !ate" "etention a"e common/ )eenan# $ pe"g/ cemia an# $ pe"("icemia ma a/)o occ("+ Enalaprilat T$e ()e o1 angioten)in5con%e"ting en4 me 6ACE7 in$i3ito") 1o" t$e t"eatment o1 $ pe"ten)i%e c"i)e) $a) 3een )t(#ie# o%e" t$e /a)t . $.!it$ a peak action at *B min.=.t$e BP )$o(/# not 3e /o!e"e#.c/oni#ine !a) 1o(n# to p"o#(ce a mo"e g"a#(a/ #ec"ea)e in BP t$an ni1e#ipine+<@ Se#ation !a) o3)e"%e# in t$o)e patient) taking c/oni#ine+ T$i) me#ication i) an e2ce//ent c$oice 1o" t$o)e patient) in !$om "api# cont"o/ o1 BP i) not "e8(i"e#+ Dia&o'ide T$i) #"(g "e/a2e) a"te"io/a" )moot$ m()c/e an# $a) 3een ()e# in t$e t"eatment o1 )e%e"e $ pe"ten)ion+=B 9$en gi%en IV.!it$ a #("ation o1 action o1 > to @ $+ In a "an#om.p"og"e))ing to an in5(te"o #eat$ o" to pe"inata/ a)p$ 2ia+ A1te" #e/i%e" .B min to . #eca#e)+<.agent) t$at can 3e a#mini)te"e# IV t$at a"e "api# acting.

("ine 1/o! "ate).an# $a) 3een a#mini)te"e# IV to G *-BBB patient)+ In a p"o)pecti%e.1eno/#opam $a) 3een #emon)t"ate# to imp"o%e c"eatinine c/ea"ance.g/(c("oni#ation.ACE in$i3ito") a"e cont"ain#icate# in p"egnanc +=.an# "e)(/t) in #i("e)i) an# nat"i("e)i)+?.B to >B min.!it$ a #("ation o1 action o1 *.it) ()e i) not a))ociate# !it$ t$e a#%e")e e11ect) "e/ate# to M*5 an# :*5acti%ation+ Feno/#opam acti%ate) #opamine"gic "ecepto") on t$e p"o2ima/ an# #i)ta/ t(3(/e)."an#omi4e#.!$e"ea) t$e)e . to .an# )(/1ation+ On/ <J o1 t$e a#mini)te"e# #o)e i) e2c"ete# (nc$ange#+ Anima/ #ata in#icate t$at t$e meta3o/ite) a"e inacti%e+?< T$e on)et o1 action i) !it$in = min.!it$ t$e p"e))("e g"a#(a// "et("ning to p"et"eatment %a/(e) !it$o(t "e3o(n# once t$e in1()ion i) )toppe#+?=?>?? No a#%e")e e11ect) $a%e 3een "epo"te#+?= T$e #o)e "ate o1 1eno/#opam m()t 3e in#i%i#(a/i4e# acco"#ing to 3o# !eig$t an# acco"#ing to t$e #e)i"e# "api#it an# e2tent o1 t$e p$a"maco# namic e11ect+ An initia/ )ta"ting #o)age o1 B+* LgHkgHmin i) "ecommen#e#+ Feno/#opam $a) 3een (n#e" c/inica/ in%e)tigation )ince *A@*.make it t$e Ci#ea/ :5 a#"ene"gic 3/ocke"D 1o" ()e in c"itica// i// patient)+ T$i) agent i) a%ai/a3/e 1o" IV ()e.conc/(#ing t$at 3ot$ agent) $a# e8(i%a/ent e11icac + Ho!e%e".< $+ Hi")c$/ an# co//eag(e)=? $a%e #emon)t"ate# t$at t$e #eg"ee o1 t$e BP "e#(ction !it$ IV ena/ap"i/at i) co""e/ate# !it$ t$e p"et"eatment concent"ation o1 angioten)in II an# p/a)ma "enin acti%it + No a#%e")e )i#e e11ect) o" ) mptomatic $ poten)ion $a) 3een "epo"te# !it$ IV ena/ap"i/atF $o!e%e".?.m(/ticente" c/inica/ t"ia/Panacek an# co!o"ke")?@ compa"e# 1eno/#opam !it$ nit"op"())i#e in t$e t"eatment o1 ac(te $ pe"ten)ion.!it$o(t pa"ticipation o1 c toc$"ome P5 <=B en4 me)+ T$e p"incipa/ "o(te) o1 conI(gation a"e met$ /ation.B min+>B>*>.t$e 1o"me" i) $ig$/ )peci1ic 1o" on/ DA* "ecepto") an# i) *B time) mo"e potent t$an DA a) a "ena/ %a)o#i/ato"+?* T$e )peci1ic "ecepto" acti%ation i) o1 pa"amo(nt %a/(e in t$e #i11e"entiation o1 action) 3et!een DA an# 1eno/#opam+ A) 1eno/#opam inte"act) on/ !it$ DA* "ecepto").=? Esmolol E)mo/o/ i) a ca"#io)e/ecti%e.!it$ a #("ation o1 action o1 *B to .$a) gaine# pop(/a"it 1o" ()e in )ome $ pe"ten)i%e eme"gencie)+=. T$e p$a"macokinetic p"ope"tie) o1 e)mo/o/.in$i3it) )o#i(m "ea3)o"ption.!it$ t$e ma2ima/ "e)pon)e 3eing ac$ie%e# 3 *= min+?=?>?? T$e #("ation o1 action i) 3et!een .><>=>>>?>@>A E)mo/o/ $a) p"o%en )a1e in patient) !it$ ac(te m oca"#ia/ in1a"ctione%en t$o)e !$o $a%e "e/ati%e cont"ain#ication) to :53/ocke")+?B T$e "ecommen#e# initia/ #o)e i) B+= mgHkg 1o//o!e# 3 an in1()ion at .===>=?=@=A Ena/ap"i/at $a) an on)et o1 action !it$in *= min. T$e meta3o/i)m o1 e)mo/o/ i) %ia "api# $ #"o/ )i) 3 RBC) an# i) not #epen#ent on "ena/ o" $epatic 1(nction+ T$e on)et o1 action i) !it$in >B ).BB LgHkgHmin+ (enoldopam T$i) agent $a) "ecent/ 3een app"o%e# 1o" t$e management o1 ac(te $ pe"ten)ion in t$e Unite# State)+ It i) a #opamine 6DA7* agoni)t t$at i) )$o"t acting an# $a) t$e a#%antage) o1 inc"ea)ing "ena/ 3/oo# 1/o! an# )o#i(m e2c"etion+ Feno/#opam $a) "e/ati%e/ (ni8(e action) an# "ep"e)ent) a ne! catego" o1 anti$ pe"ten)i%e me#ication+ 9$i/e t$e )t"(ct("e o1 1eno/#opam i) 3a)e# on DA.= to . Feno/#opam i) "api#/ an# e2ten)i%e/ meta3o/i4e# 3 conI(gation in t$e /i%e".3ot$ a) a 3o/() an# a) an in1()ion+ It i) o1 pa"tic(/a" %a/(e 1o" )ome )(p"a%ent"ic(/a" # )"$ t$mia)an# "ecent/ $a) 3een ()e# in patient) !it$ $ pe"ten)i%e c"i)e) an# po)tope"ati%e $ pe"ten)ion+>.:5a#"ene"gic 3/ocking agent t$at $a) an e2t"eme/ )$o"t #("ation o1 action+>B>*>.an# )o#i(m e2c"etion in )e%e"e/ $ pe"ten)i%e patient) !it$ 3ot$ no"ma/ an# impai"e# "ena/ 1(nction.open5/a3e/.

inc"ea)ing t$e in1()ion "ate 3 ..an in1()ion commencing at * to .?A@B Feno/#opam ma t$e"e1o"e 3e t$e #"(g o1 c$oice in )e%e"e/ $ pe"ten)i%e patient) !it$ impai"e# "ena/ 1(nction+@* $abetalol La3eta/o/ i) a com3ine# 3/ocke" o1 M5 an# :5a#"ene"gic "ecepto")+ 'i%en IV.@ It) #o)e i) in#epen#ent o1 t$e patientO) !eig$t+ T$e c(""ent "ecommen#e# #o)age 1o" "api# BP cont"o/ i) = mgH$.an IV 1o"m o1 nica"#ipine $a) 3een a%ai/a3/e an# app"o%e# in t$e Unite# State) 1o" t$e t"eatment o1 )e%e"e $ pe"ten)ion+ Nica"#ipine i) a #i$ #"op "i#ine5 #e"i%ati%e ca/ci(m c$anne/ 3/ocke"+ It #i11e") 1"om ni1e#ipine 3 t$e a##ition o1 a te"tia" amine )t"(ct("e in t$e e)te" )i#e c$ain 1"om po)ition t$"ee o1 t$e $ #"op "i#ine "ing an# t$e mo%ement o1 t$e nit"o g"o(p to t$e meta po)ition o1 t$e p$en / "ing+A*A.making nica"#ipine a tit"ata3/e IV ca/ci(m c$anne/ 3/ocke"+ T$e on)et o1 action o1 IV nica"#ipine i) 3et!een = to *= min."an#omi4e# )t(# compa"ing t$e e11ect o1 t$i) agent !it$ nit"op"())i#e in patient) !it$ )e%e"e po)tope"ati%e $ pe"ten)ion+ T$e)e a(t$o") "epo"te# nica"#ipine to 3e a) e11ecti%e a) )o#i(m nit"op"())i#e+ IV nica"#ipine.it can 3e a#mini)te"e# IV.@< Hea"t "ate i) maintaine# o" )/ig$t/ "e#(ce# #(e to it) :53/ocking e11ect+ Un/ike p("e :53/ocke").$a) 3een )$o!n to "e#(ce 3ot$ ca"#iac an# ce"e3"a/ i)c$emia+.an# co"ona" 3/oo# 1/o! a"e maintaine#+@=@>@?@@ Litt/e p/acenta/ t"an)1e" occ(").a1te" t$e initia/ /oa#ing #o)e.A<A=A>A?A@AA T$e"e $a%e a/)o 3een )e%e"a/ )t(#ie) p(3/i)$e# compa"ing t$e e11ect) o1 nica"#ipine !it$ )o#i(m nit"op"())i#e+ Ha/pe"n an# coa(t$o")A= con#(cte# a m(/ticente"./a3eta/o/ maintain) ca"#iac o(tp(t+@= La3eta/o/ "e#(ce) pe"ip$e"a/ %a)c(/a" "e)i)tance !it$o(t "e#(cing pe"ip$e"a/ 3/oo# 1/o!F ce"e3"a/.1o//o!e# 3 "epeate# inc"ementa/ #o)e) o1 . T$e maIo"it o1 t$e #"(g i) meta3o/i4e# 3 t$e /i%e" to 1o"m an inacti%e g/(c("oni#e conI(gate+@.a) !e// a) patient) !it$ ac(te m oca"#ia/ in1a"ction !it$ ) )temic $ pe"ten)ion+@=@?@A A /oa#ing #o)e o1 .3o/() inIection) o1 * to .!$ic$ #ec"ea)e ca"#iac o(tp(t.main/ #(e to t$e neg/igi3/e /ipi# )o/(3i/it o1 t$e #"(g+@= La3eta/o/ $a) 3een )$o!n to 3e e11ecti%e an# )a1e in t$e management o1 $ pe"ten)i%e eme"gencie)."eac$e) it) peak at = to *= min. mgHkg $a%e 3een "epo"te# to p"o#(ce p"ecipito() 1a//) in BP an# )$o(/# t$e"e1o"e 3e a%oi#e#+AB )icardipine O%e" t$e /a)t = ea")."ena/.p"o)pecti%e. to = min a1te" an IV #o)e.+= mgH$ e%e" = min 6to a ma2im(m o1 *= mgH$7 (nti/ t$e #e)i"e# BP "e#(ction i) ac$ie%e#+ )ifedipine .!it$ a #("ation o1 action o1 < to > $+ Se%e"a/ )t(#ie) $a%e e2amine# t$e ac(te e11ect) o1 nica"#ipine !$en a#mini)te"e# to patient) !it$ )e%e"e $ pe"ten)ion+.$o!e%e". T$e)e #i11e"ence) make nica"#ipine *BB time) mo"e !ate" )o/(3/e t$an ni1e#ipine.pa"amete") 1a// in patient) t"eate# !it$ nit"op"())i#e+?.@<A. mgHmin an# tit"ate# (p to (nti/ t$e #e)i"e# $ poten)i%e e11ect i) ac$ie%e# ma 3e pa"tic(/a"/ e11ecti%e+ Once t$e ta"get BP $a) 3een ac$ie%e#.o"a/ t$e"ap can 3e initiate#+ La"ge.an# pe")i)t) 1o" a3o(t .an#.B mg i) "ecommen#e#.B to @B mg gi%en at *B5min inte"%a/) (nti/ t$e t$e"ape(tic goa/ i) ac$ie%e#+ A/te"nati%e/ .t$e MH:53/ocking "atio i) *N?+@. T$e $ poten)i%e e11ect o1 /a3eta/o/ 3egin) !it$in .t$e"e1o"e. to < $+@.

!eek).J %) *.an# p"egnanc 5in#(ce# $ pe"ten)ion+.t$i) #"(g hould not )e u ed 1o" BP cont"o/ in patient) !it$ $ pe"ten)i%e c"i)e)+ )itropr sside So#i(m nit"op"())i#e i) an a"te"ia/ an# %eno() %a)o#i/ato" t$at #ec"ea)e) 3ot$ a1te"/oa# an# p"e/oa#+*B<*B=*B>*B?*B@ T$i) #"(g "eact) !it$ c )teine to 1o"m nit"oc )teine+ T$e /ate" acti%ate) g(an /ate c c/a)e. to < min+*B<*B=*B>*B?*B@**.!it$ a #("ation o1 action o1 * to .*BB*B**B.B Ra($a/a an# co//eag(e)*..B to >B min an# a #("ation o1 action o1 a3o(t > $+*BB T$i) 1o"m o1 t$e"ap .t$e amo(nt gene"ate# 3eing #epen#ent on t$e #o)e o1 nit"op"())i#e a#mini)te"e#+ C ani#e i) meta3o/i4e# in t$e /i%e" to t$ioc anate+ T$io)(/1ate i) "e8(i"e# 1o" t$i) "eaction+*B?**> T$ioc anate i) *BB time) /e)) to2ic t$an c ani#e+ T$e t$ioc anate gene"ate# i) e2c"ete# /a"ge/ t$"o(g$ t$e ki#ne )+ C ani#e "emo%a/ t$e"e1o"e "e8(i"e) a#e8(ate /i%e" 1(nction.)(##en "e#(ction) in BP accompan ing t$e a#mini)t"ation o1 ni1e#ipine ma p"ecipitate ce"e3"a/.!$ic$ i) con%e"te# into t$ioc anate 3 t$e en4 me t$io)(/1ate )(/1("t"an)1e"a)e+*B? Nit"op"())i#e contain) <<J c ani#e 3 !eig$t+ C ani#e i) "e/ea)e# nonen4 matica// 1"om nit"op"())i#e.*.<.!it$ $ #"o2 / "a#ica/ an# pe"o2 nit"ite gene"ation /ea#ing to /ipi# pe"o2i#ation+**?**@ Nit"op"())i#e ma a/)o ca()e c toto2icit #(e to t$e "e/ea)e o1 c ani#e!it$ inte"1e"ence o1 ce//(/a" "e)pi"ation+**A*.."ena/.? Beca()e t$e $ poten)i%e e11ect) o1 ni1e#ipine cannot 3e c/o)e/ "eg(/ate#.@<= A) mentione# ea"/ie".* #emon)t"ate# /ipi# pe"o2i#ation in t$e )(3)tantia nig"a o1 "at) a1te" t$e a#mini)t"ation o1 nit"op"())i#e+ Lipi# pe"o2i#ation $a) a/)o 3een #emon)t"ate# in $epatoc te)+**A In a##ition.a#e8(ate "ena/ 1(nction.an# i""e%e")i3/e . I1 t$e in1()ion i) )toppe# a3"(pt/ .<+.t$e BP 3egin) to "i)e imme#iate/ an# "et("n) to t$e p"et"eatment /e%e/ !it$in * to *B min+ In patient) !it$ co"ona" a"te" #i)ea)e.?. min an# a p/a)ma $a/15/i1e o1 .+?J7+**= So#i(m nit"op"())i#e i) meta3o/i4e# into c anogen.nit"op"())i#e ca()e) concent"ation an# time5#epen#ent ototo2icit +*.con%(/)ion).*B.a )igni1icant "e#(ction in "egiona/ 3/oo# 1/o! 6co"ona" )tea/7 can occ("+**< In a /a"ge "an#omi4e#p/ace3o5cont"o//e# t"ia/.ce"e3"a/ 3/oo# 1/o! 6CBF7 ma #ec"ea)e in a #o)e5#epen#ent manne"+ F("t$e"mo"e.in t("n. C ani#e to2icit $a) 3een #oc(mente# to "e)(/t in C(ne2p/aine# ca"#iac a""e)t-D coma.an# m oca"#ia/ i)c$emic e%ent) t$at $a%e 3een a))ociate# !it$ 1ata/ o(tcome)+. Nit"op"())i#e i) a %e" potent agent+ T$e on)et o1 action o1 t$i) #"(g i) !it$in )econ#).i) not C3enign+D.3(t i) "api#/ a3)o"3e# 1"om t$e 'I t"act a1te" t$e cap)(/e i) 3"oken an# #i))o/%e#+<< Ni1e#ipine ca()e) #i"ect %a)o#i/atation o1 a"te"io/e)"e#(cing pe"ip$e"a/ %a)c(/a" "e)i)tance+ A )igni1icant #ec"ea)e in BP i) o3)e"%e# = to *B min a1te" ni1e#ipine a#mini)t"ation.!$ic$.? E/#e"/ $ pe"ten)i%e patient) !it$ (n#e"/ ing )t"(ct("a/ %a)c(/a" #i)ea)e an# ta"get o"gan impai"ment ten# to 3e mo"e %(/ne"a3/e to t$e "api# an# (ncont"o//e# "e#(ction in a"te"ia/ p"e))("e+.!it$ a peak e11ect at 3et!een .O"a/H)(3/ing(a/ t$e"ap !it$ )$o"t5acting ni1e#ipine $a) 3een !i#e/ ()e# in t$e management o1 $ pe"ten)i%e eme"gencie).an# a#e8(ate 3ioa%ai/a3i/it o1 t$io)(/1ate+ So#i(m nit"op"())i#e $a) 3een #emon)t"ate# to ca()e c toto2icit t$"o(g$ t$e "e/ea)e o1 nit"ic o2i#e.)tim(/ate) t$e 1o"mation o1 c c/ic g(ano)ine monop$o)p$ate t$at "e/a2e) )moot$ m()c/e+ 9$en ()ing t$i) agent. Ni1e#ipine i) not a3)o"3e# t$"o(g$ t$e 3(cca/ m(co)a.)e%e"e $ pe"ten)ion a))ociate# !it$ c$"onic "ena/ 1ai/("epe"iope"ati%e $ pe"ten)ion.$o!e%e"..nit"op"())i#e !a) )$o!n to inc"ea)e mo"ta/it !$en in1()e# in t$e ea"/ $o(") a1te" ac(te m oca"#ia/ in1a"ction 6mo"ta/it at *.A<B<*<.3ot$ c/inica/ an# e2pe"imenta/ )t(#ie) #emon)t"ate t$at nitropru ide increa e intracranial pre ure+*BA**B*****.encep$a/opat$ .

$ ma /ea# to c ani#e /e%e/) t$at a"e in t$e to2ic "ange+*B? T$e "ecommen#e# #o)e) o1 nit"op"())i#e o1 (p to *B LgHkgHmin "e)(/t in c ani#e 1o"mation at a 1a" g"eate" "ate t$an $(man 3eing) can #eto2i1 + Con)i#e"ing t$e potentia/ 1o" )e%e"e to2icit !it$ nit"op"())i#e..ma 3e gi%en+ Trimethaphan Camsylate T"imet$ap$an cam) /ate i) a non#epo/a"i4ing gang/ionic 3/ocking agent+ It 3/ock) t$e t"an)mi))ion o1 imp(/)e) at t$e ) mpat$ic an# pa"a) mpat$ic gang/ia 3 competing !it$ acet /c$o/ine 1o" c$o/ine"gic "ecepto")+? T$i) acco(nt) 1o" 3ot$ it) e11icac an# it) n(me"o() )i#e e11ect)+ T$e "e#(ction in BP o3)e"%e# !it$ t$i) agent i) ca()e# 3 t$e a#"ene"gic 3/ocka#e "e)(/ting in %a)o#i/atation+ T$e on)et o1 action i) !it$in * to = min.t$i) #"(g )$o(/# 3e ()e# on/ !$en ot$e" IV anti$ pe"ten)i%e agent) a"e not a%ai/a3/e.an# t$en on/ in patient) !it$ no"ma/ "ena/ an# $epatic 1(nction+*B@ T$e #("ation o1 t"eatment )$o(/# 3e a) )$o"t a) po))i3/ean# t$e in1()ion "ate )$o(/# not 3e G .< T$e c(""ent met$o#) o1 monito"ing 1o" c ani#e to2icit a"e in)en)iti%e+ Meta3o/ic aci#o)i) i) ()(a// a p"ete"mina/ e%ent+ In a##ition..7..a /ong5acting M5a#"ene"gic 3/ocking agent.$o!e%e".?*@.> T$i) me#ication i) gi%en IV in *5 to =5mg 3o/()e)+ T$e e11ect i) imme#iate an# ma /a)t (p to *= min+ Contin(o() IV in1()ion) $a%e a/)o 3een ()e# !it$ %a"ia3/e e11ect)+ T$i) agent ma ca()e tac$ # )"$ t$mia) o" angina+ Once t$e initia/ BP i) (n#e" cont"o/.it i) impo"tant to emp$a)i4e t$at nit"og/ ce"in i) not an e11ecti%e %a)o#i/ato"+*..p$eoc$"omoc toma7+.!it$ a #("ation o1 action o1 *B min+ T$e a#mini)t"ation i) 3 con)tant IV in1()ion 6=BB mg i) mi2e# in =BB mL o1 =J #e2t"o)e !ate"7.= mgH$+ H #"o2oco3a/amin i) (n)ta3/e an# )$o(/# 3e )to"e# #" an# p"otecte# 1"om /ig$t+ C anoco3a/amin 6B*.a7 i) )a1e an# e11ecti%e in p"e%enting an# t"eating c ani#e to2icit a))ociate# !it$ t$e ()e o1 nit"op"())i#e+ T$i) ma 3e gi%en a) a contin(o() in1()ion at a "ate o1 .an# nit"og/ ce"in ma p/a a )igni1icant "o/e in t$o)e patient) !it$ ca"#iac i)c$emia+ Ho!e%e". #a ) o1 a#mini)t"ation+ *ther Agents Nit"og/ ce"in an# $ #"a/a4ine a"e )ometime) ()e# in t$e t"eatment o1 $ pe"ten)i%e c"i)e).1oca/ ne("o/ogic a3no"ma/itie)+*B@*.i) ine11ecti%e a) an anti#ote an# i) not capa3/e o1 p"e%enting c ani#e to2icit + Phentolamine P$ento/amine i) an M5a#"ene"gic 3/ocking agent t$at i) 1"e8(ent/ ()e# 1o" management o1 catec$o/amine5in#(ce# $ pe"ten)i%e c"i)e) 6ie.o"a/ p$eno2 3en4amine.an# i) gi%en a) initia/ #o)age o1 B+= to * mgHmin+ T$e #o)e i) t$en tit"ate# to ac$ie%e t$e #e)i"e# BP (p to a ma2im(m o1 *= mgHmin+ Tac$ p$ /a2i) i) a common )i#e e11ect !it$ t$i) me#ication+ It ()(a// occ(") !it$in t$e 1i")t .a "i)e in )e"(m t$ioc anate /e%e/) i) a /ate e%ent an# not #i"ect/ "e/ate# to c ani#e to2icit + RBC c ani#e concent"ation) 6a/t$o(g$ not !i#e/ a%ai/a3/e7 ma 3e a mo"e "e/ia3/e met$o# o1 monito"ing 1o" c ani#e to2icit +*B? An RBC c ani#e concent"ation G <B nmo/HmL "e)(/t) in #etecta3/e meta3o/ic c$ange)+ Le%e/) G .BB nmo/HL a"e a))ociate# !it$ )e%e"e c/inica/ ) mptom). to .= Nit"og/ ce"in i) a potent %eno#i/ato".an# /e%e/) G <BB nmo/HmL a"e con)i#e"e# /et$a/+*B? Data )(gge)t t$at nit"op"())i#e in1()ion "ate) G < LgHkgHmin 1o" a) /itt/e a) . LgHkgHmin+ An in1()ion o1 t$io)(/1ate )$o(/# 3e ()e# in patient) "ecei%ing $ig$e" #o)age) 6< to *B LgHkgHmin7 o1 nit"op"())i#e+**> It $a) a/)o 3een #emon)t"ate# t$at $ #"o2oco3a/amin 6%itamin *.an# on/ at $ig$ #o)e) a11ect) a"te"ia/ tone+ Nit"og/ ce"in "e#(ce) BP 3 .

an# i/e()+ Ca"#io%a)c(/a" )("gica/ con)(/tation i) "e8(i"e# in a// patient) !it$ )()pecte# ao"tic #i))ection)+ S("ge" i) in#icate# 1o" a// #i))ection) in%o/%ing t$e a)cen#ing ao"ta 6t pe A #i))ection7.* T$i) ma e2p/ain t$e p"o/onge# p$a"maco/ogic e11ect o1 t$e #"(g+ Beca()e o1 t$e p"o/onge# an# (np"e#icta3/e anti$ pe"ten)i%e e11ect) o1 t$e #"(g.= T"imet$ap$an.nica"#ipine o" 1eno/#opam i) a /e))5to2ic a/te"nati%e+*.an M5 an# :5a#"ene"gic antagoni)t.*.it "e8(i"e) )pecia/ t(3ing 1o" a#mini)t"ation+ H #"a/a4ine $a) 3een ()e# a) an anti$ pe"ten)i%e agent 1o" G <B ea")+ Fo//o!ing an IM o" IV #o)e.$ #"a/a4ine )$o(/# 3e a%oi#e# in t$e management o1 $ pe"ten)i%e eme"gencie)+ Ot$e" "egimen) (ti/i4ing me#ication) )(c$ a) "e)e"pine. 9$i/e )o#i(m nit"op"())i#e $a) t"a#itiona// 3een ()e# in patient) !it$ ao"tic #i))ection.o" g(anet$i#ine $a%e /a"ge/ 3een "ep/ace# 3 t$e agent) #e)c"i3e# a3o%e+ P"e%io() SectionNe2t Section Treatment in +pecial +it ations Ac te Aortic Dissection IV anti$ pe"ten)i%e t"eatment )$o(/# 3e )ta"te# in t$e eme"genc #epa"tment in a// patient) 6e2cept patient) !it$ $ poten)ion7 a) )oon a) t$e #iagno)i) o1 ac(te ao"tic #i))ection i) )()pecte# 6Ta3/e < 7+*.(n#e)i"a3/e e11ect) in patient) !it$ comp"omi)e# ce"e3"a/ an# "ena/ pe"1()ion+ In a##ition.t$e"e i) an initia/ /atent pe"io# o1 = to *= min 1o//o!e# 3 a p"og"e))i%e 6o1ten p"ecipito()7 1a// in BP /a)ting 1o" (p to *.an# ne("o/ogic )ign) )$o(/# 3e c/o)e/ monito"e# 1o" an #ete"io"ation o!ing to comp/ication)+ T$e aim o1 anti$ pe"ten)i%e t$e"ap i) to /e))en t$e p(/)ati/e /oa# o" ao"tic )t"e)) 3 /o!e"ing t$e BP+ Re#(cing t$e 1o"ce o1 /e1t %ent"ic(/a" cont"action) an#.? Patient) !it$ $ poten)ion )(gge)ting ao"tic "(pt("e a"e .it i) /e)) p"e#icta3/e t$an )o#i(m nit"op"())i#e an# $a) )i#e e11ect) o1 tac$ p$ /a2i).o" conge)ti%e $ea"t 1ai/("e+ An a#%antage o%e" )o#i(m nit"op"())i#e i) t$at it "e#(ce) 3ot$ a"te"ia/ p"e))("e an# it) "ate o1 inc"ea)e. $+*.>*.B*.("ine o(tp(t.* T$e)e patient) m()t 3e a#mitte# to an ICU a) an eme"genc + Va)c(/a" p"e))("e).)e%e"e $ poten)ion. $.< La3eta/o/.an# t$e"e1o"e it #oe) not "e8(i"e conc(""ent ()e o1 :53/ocke")+ Ho!e%e".t$e "ate o1 "i)e o1 ao"tic p"e))("e "eta"#) t$e p"opagation o1 t$e #i))ection an# ao"tic "(pt("e+ T$e com3ination o1 a %a)o#i/ato" an# a :53/ocke" i) t$e )tan#a"# anti$ pe"ten)i%e "egimen ()e# in t$e)e patient)F a %a)o#i/ato" a/one ma ca()e an inc"ea)e in %e/ocit o1 %ent"ic(/a" cont"action an# /ea# to p"opagation o1 #i))ection+ E)mo/o/ i) t$e :5a#"ene"gic antagoni)t o1 c$oice+*."e#(cing p"e/oa# an# ca"#iac o(tp(t.A*.i) an a/te"nati%e to t$e com3ination o1 nit"op"())i#e an# :53/ocke"+*.("ina" "etention.3"a# ca"#ia.met$ /#opa.can 3e ()e# !$en )o#i(m nit"op"())i#e i) ine11ecti%e o" poo"/ to/e"ate#.o" !$en t$e ()e o1 :53/ocke") i) a "e/ati%e cont"ain#ication #(e to p"ee2i)ting con#ition) )(c$ a) COPD.con)e8(ent/ .a gang/ionic 3/ocke" a) !e// a) #i"ect %a)o#i/ato".menta/ )tat().? A/t$o(g$ t$e ci"c(/ating $a/15/i1e o1 t$e #"(g i) a3o(t .an# t$e ina3i/it to e11ecti%e/ tit"ate it) $ poten)i%e e11ect.>*.t$e $a/15time o1 it) e11ect on BP i) a3o(t *BB $+*.@ H #"a/a4ine $a) 3een #emon)t"ate# to 3in# to t$e !a//) o1 m()c(/a" a"te"ie)+*....!it$ t$e e2ception o1 on/ a 1e! patient) !it$ )e"io() a))ociate# con#ition) cont"ain#icating )("ge" +*. Metop"o/o/ i) a )(ita3/e a/te"nati%e+*.

!$ic$.o" pe")i)tent pain #e)pite an a#e8(ate me#ica/ "egimen a"e 3e)t t"eate# 3 )("ge" + Po(nge" patient) !it$ Ma"1anO) ) n#"ome ma 3ene1it 1"om )("ge" in t$e )(3ac(te p$a)e an# a%oi# "(pt("e o1 a "e)i#(a/ )acc(/a" ane(" )m in t$e 1(t("e+ Patient) !it$ (ncomp/icate# #i)ta/ #i))ection) a"e 3e)t manage# me#ica// in t$e ac(te p$a)e !it$ anti$ pe"ten)i%e t$e"ap .< patient) !it$ ac(te )t"oke a#mitte# to t$e $o)pita/.o" "ena/ #i)ea)e)+ Hypertension After a Cerebrovasc lar Accident In $ea/t$ $(man).B mm Hg.!it$ a $i)to" o1 ca"#iac.o" a))ociate# e#ema+ T$e"e i) no e%i#ence t$at $ pe"ten)ion $a) a #e/ete"io() e11ect on t$e o(tcome o1 i)c$emic )t"oke) #("ing t$e ac(te p$a)e+.in patient) !it$ c$"onic $ pe"ten)iona(to"eg(/ation i) )et at a $ig$e" /e%e/ 6app"o2imate/ *..t$e %a/(e o1 ea"/ anti$ pe"ten)i%e t$e"ap in p"e%enting "e3/ee#ing o" "e#(cing %a)ogenic e#ema $a) not 3een #emon)t"ate#+ Ho!e%e"!it$ "a#io/ogic e%i#ence o1 a maIo" int"ace"e3"a/ 3/ee#.3eca()e o1 impai"e# a(to"eg(/ation.t$e)e patient) a"e gene"a// in t$e o/#e" age g"o(p..B to *.BB mm Hg o" a #ia)to/ic BP G *.< $ a1te" an int"ace"e3"a/ $emo""$age !a) a))ociate# !it$ inc"ea)e# mo"ta/it +*<= In t$i) )t(# .an# p"e)ence o1 %ent"ic(/a" 3/oo#+ .a 1a// in BP ma "e)(/t in 1("t$e" in1a"ction in%o/%ing t$e enti"e te""ito" o1 t$at a"te" + T$e c(""ent "ecommen#ation) o1 t$e Ame"ican Hea"t A))ociation i) t$at $ pe"ten)ion in t$e )etting o1 ac(te i)c$emic )t"oke )$o(/# 3e t"eate# on/ C"a"e/ an# ca(tio()/ +D*<**<.? A1te" a )t"oke.impai"ment o1 3/oo# 1/o! to an o"gan o" /im3.A*<B*<.t$e "ate o1 #ec/ine in BP !a) in#epen#ent/ a))ociate# !it$ inc"ea)e# mo"ta/it + T$e e11ect !a) in#epen#ent o1 ot$e" %a"ia3/e) kno!n to co""e/ate !it$ o(tcome a1te" int"ace"e3"a/ $emo""$age. In patient) !it$ int"ace"e3"a/ $emo""$age.* A/)o.ce"e3"a/ $emo""$age.B mm Hg i) gene"a// )(gge)te#+*.p"e)(ma3/ to p"otect t$e 3"ain 1"om t$e e11ect) o1 pe")i)tent $ pe"ten)ion 6Fig *7+.ca(tio() /o!e"ing o1 a ) )to/ic BP G .a) )("%i%a/ "ate i) a"o(n# ?=J !$et$e" patient) a"e t"eate# me#ica// o" )("gica// +.ce"e3"a/ a(to"eg(/ation maintain) con)tant CBF 3et!een a mean ) )temic a"te"ia/ p"e))("e o1 >B an# *.BJ in t$e 1i")t .B to *>B mm Hg7.can#i#ate) 1o" eme"genc )("gica/ "epai"+ Comp/ication) o1 t pe B #i))ection).B mm Hg+ Ho!e%e"..on/ one t$i"# o1 patient) "emaine# $ pe"ten)i%e+ T$e mec$ani)m) (n#e"/ ing $ pe"ten)ion a1te" a ce"e3"o%a)c(/a" acci#ent $a%e not 3een 1(// e/(ci#ate#+ Acti%ation o1 t$e ) mpat$etic ne"%o() ) )tem ma 3e in%o/%e# a) pa"t o1 a g/o3a/ meta3o/ic "e)pon)e to ce"e3"a/ in1a"ction.initia/ '/a)go! Coma Sca/e )co"e.*.)(c$ a) /eakage o1 3/oo# 1"om t$e ao"ta.@ 1o(n# t$at G @BJ $a# e/e%ate# BP on t$e #a o1 a#mi))ion+ T$e BP) 1e// )pontaneo()/ an# g"a#(a// o%e" t$e ne2t *B #a )+ B t$e *Bt$ #a a1te" t$e )t"oke.A*<B Lo!e"ing t$e BP in patient) !it$ ce"e3"a/ i)c$emia ma "e#(ce CBF.< $+.t$e no"ma/ mec$ani)m) o1 ce"e3"a/ a(to"eg(/ation a"e impai"e#+ Pe"1()ion in t$e i)c$emic pen(m3"a 3ecome) p"e))("e #epen#ent+ A "i)e in ) )temic a"te"ia/ p"e))("e ma 3e an a#apti%e "e)pon)e to maintain t$e 3/oo# 1/o! to t$i) %(/ne"a3/e a"ea+ In a )e"ie) o1 .inc/(#ing $ematoma %o/(me. It i) gene"a// "ecommen#e# t$at anti$ pe"ten)i%e t$e"ap 3e "e)e"%e# 1o" patient) !it$ a #ia)to/ic p"e))("e G *.p(/mona" .*.A*<B*<< T$i) "ecommen#ation i) )(ppo"te# 3 a "ecent )t(# t$at #emon)t"ate# t$at "api# #ec/ine in BP !it$in t$e 1i")t .9a//ace an# Le% *.ma "e)(/t in 1("t$e" i)c$emic inI(" + T$e common p"actice o1 Cno"ma/i4ingD BP i) potentia// #ange"o()+ 9$en a p"o2ima/ a"te"ia/ o3)t"(ction "e)(/t) in a mi/# )t"oke.aiming to "e#(ce t$e p"e))("e 3 no mo"e t$an an a"3it"a" 1ig("e o1 .

t$e p"e)entation o1 a patient !it$ p"egnanc 5in#(ce# $ pe"ten)ion ma "ange 1"om a mi/# to a /i1e5t$"eatening #i)ea)e p"oce))+ T$e p"oce)) can 3e en#e# on/ 3 #e/i%e" + T$e #eci)ion to contin(e o" to #e/i%e" t$e p"egnanc !i// 3e ma#e 3 con)(/tation 3et!een me#ica/ an# o3)tet"ic pe")onne/+ Mo)t p"eec/amptic patient) a"e %a)ocon)t"icte# an# $emoconcent"ate#+ A1te" initia/ t$e"ap %o/(me e2pan)ion an# $emo#i/(tion occ("+ Magne)i(m )(/1ate i) con)i#e"e# t$e )tan#a"# o1 t$e"ap a) a p"op$ /a2i) 1o" )ei4("e acti%it *<>*<?F t$e /oa#ing #o)e i) < to > g in *BB mL #e2t"o)e B+.a) in '(i//ian5Ba""Q ) n#"ome+ T$e ()e o1 :53/ocke") )$o(/# 3e a%oi#e# in t$e)e patient).)ince in$i3ition o1 :R"ecepto"5 in#(ce# %a)o#i/ation "e)(/t) in (noppo)e# M5a#"ene"gic %a)ocon)t"iction an# a 1("t$e" "i)e in BP+ T$e ()e o1 :53/ocke") $a) 3een #emon)t"ate# to en$ance cocaine5in#(ce# co"ona" %a)ocon)t"iction.nica"#ipine o" 1eno/#opam i) a )(ita3/e a/te"nati%e+ IV o" o"a/ ACE in$i3ito").cont"o//e# e2pe"iment) in anima/) an# $(man) #o not )(ppo"t it) .amp$etamine).)$o"t5acting IV agent) a"e p"e1e""e#+ T$e)e )$o(/# 3e a#mini)te"e# in an ICU (n#e" c/o)e BP monito"ing+ 9$i/e nit"op"())i#e i) common/ ()e# in t$i) )it(ation.patient) )$o(/# 3e t"eate# a) o(t/ine# in Ta3/e <+ In a##ition to #"(g t$e"ap !it$#"a!a/.an# $ #"a/a4ine )$o(/# 3e a%oi#e# #(e to t$ei" (np"e#icta3/e an# poo"/ tit"ata3/e anti$ pe"ten)i%e e11ect)+ Preeclampsia A) mentione# p"e%io()/ .t$i) #"(g inc"ea)e) int"ace"e3"a/ p"e))("e an# $a) a %e" na""o! t$e"ape(tic in#e2. Hypertensive "rgencies and +ympathetic Crises A3"(pt #i)contin(ation o1 t"eatment !it$ a )$o"t5acting ) mpat$etic 3/ocke" 6)(c$ a) c/oni#ine o" p"op"ano/o/7 can /ea# to )e%e"e $ pe"ten)ion+ Cont"o/ o1 BP can 3e ac$ie%e# in t$i) )etting 3 "ea#mini)t"ation o1 t$e #i)contin(e# #"(g+ S$o(/# e%i#ence o1 p(/mona" e#ema o1 co"ona" i)c$emia 3e p"e)ent.ce"e3"a/ e#ema ma 3e o3)e"%e#+ H #"a/a4ine $a) 3een ()e# t"a#itiona// in t$e t"eatment o1 ec/amp)ia+ Ho!e%e".inc"ea)e BP.o"a/ o" )(3/ing(a/ ni1e#ipine.*=<*== A/t$o(g$ )ome patient) $a%e 3een t"eate# !it$ /a3eta/o/ !it$o(t a#%e")e con)e8(ence).pa"tic(/a"/ in patient) !it$ "ena/ # )1(nction 6c ani#e poi)oning7+ La3eta/o/ i) an e11ecti%e agentF $o!e%e".p$enc c/i#ine.an# a(tonomic # )1(nction.= )a/ine )o/(tion o%e" *= to .t$e"e a"e no #ata "ega"#ing t$e compa"ati%e e11ect) o1 #i11e"ent anti$ pe"ten)i%e #"(g) on CBF in i)c$emic )t"oke+ In o"#e" to p"e%ent a "api# "e#(ction in BP.i1 $ ponat"emia i) a//o!e# to occ(".inc"ea)e t$e /ike/i$oo# o1 )ei4("e)an# #ec"ea)e )("%i%a/+*=./a3eta/o/ o" nica"#ipine i) p"e1e""e#+ Bot$ o"a/ an# IV 1o"m(/ation) o1 /a3eta/o/ an# nica"#ipine appea" to 3e )a1e an# e11ecti%e agent) in $ pe"ten)i%e p"egnant patient)+*<@*<A*=B*=**=.1ai/ to cont"o/ t$e $ea"t "ate.inc"ea)e# a#"ene"gic acti%it can /ea# to )e%e"e $ pe"ten)ion in a %a"iet o1 ot$e" c/inica/ )etting)+ T$e)e inc/(#e t$e ()e o1 ) mpat$omimetic #"(g) )(c$ a) cocaine.an inc"ea)e in tota/ 3o# !ate" can "e)(/t in p(/mona" e#ema+ In "a"e ca)e).To o(" kno!/e#ge.once t$e patient i) a#mitte# to an ICU.p$eoc$"omoc toma.B min+ A con)tant in1()ion o1 * to . gH$ )$o(/# t$en 3e maintaine# #epen#ing on ("ine o(tp(t an# #eep ten#on "e1/e2e) t$at a"e c$ecke# on an $o("/ 3a)i)+ Detai/e# intake an# o(tp(t "eco"#) m()t 3e maintaine#+ Since "ena/ 1(nction i) 1"e8(ent/ impai"e#.o" t$e com3ination o1 a monoamine o2i#a)e in$i3ito" an# t$e inge)tion o1 t "amine5containing 1oo#).

a) !e// a) %a)ocon)t"iction #(e to inc"ea)e# acti%it o1 t$e "enin5angioten)in ) )tem+.*>./a3eta/o/ inc"ea)e# )ei4("e acti%it an# mo"ta/it +*=@*=A F("t$e"mo"e.+tage -enal Disease T$e mo)t impo"tant ca"#io%a)c(/a" comp/ication o1 c$"onic "ena/ 1ai/("e i) $ pe"ten)ion+ T$e ca()e o1 $ pe"ten)ion in c$"onic "ena/ 1ai/("e i) an inc"ea)e in e2t"ace//(/a" %o/(me )econ#a" to )o#i(m "etention 3 t$e #i)ea)e# ki#ne . P$ento/amine an# nit"op"())i#e a"e a/te"nati%e agent)+*>< Hypertensive Crises in End.%e"apami/.= H pe"ten)i%e c"i)e) ma e2ace"3ate "ena/ 1ai/("e an#.o" 1eno/#opam+*==*>.nee# to 3e t"eate# p"ompt/ + IV ca/ci(m c$anne/ 3/ocke") $a%e 3een ()e# 1o" t$e)e patient) !it$ )ome )(cce))+*>= Patient) ma "e8(i"e eme"gent (/t"a1i/t"ation in o"#e" to cont"o/ t$e BP+ Bi/ate"a/ nep$"ectom $a) 3een "epo"te# to Cc("eD ma/ignant $ pe"ten)ion in $emo#ia/ )i) patient)+*>> P"e%io() SectionNe2t Section Concl sion T$e ke to t$e )(cce))1(/ management o1 patient) !it$ )e%e"e/ e/e%ate# BP i) to #i11e"entiate $ pe"ten)i%e c"i)e) 1"om $ pe"ten)i%e ("gencie)+ Patient) !it$ $ pe"ten)i%e ("gencie) $a%e )e%e"e $ pe"ten)ion 6#ia)to/ic G **B mm Hg7.()e+*=>*=? In )t(#ie) o1 cocaine into2ication in anima/).inc/(#ing /a3eta/o/.t$e"e1o"e.3(t !it$o(t c/inica/ e%i#ence o1 ac(te en#5o"gan #amage+ Rapi# anti$ pe"ten)i%e t$e"ap i) not !a""ante# in t$e)e patient)+ H pe"ten)i%e c"i)e) con)tit(te a #i)tinct g"o(p o1 c/inicopat$o/ogic entitie) a))ociate# !it$ ac(te ta"get o"gan inI(" + T$e)e patient) "e8(i"e imme#iate BP "e#(ction to p"e%ent p"og"e))i%e en#5o"gan #amage+ H pe"ten)ion a))ociate# !it$ ce"e3"a/ in1a"ction o" int"ace"e3"a/ $emo""$age on/ "a"e/ "e8(i"e) t"eatment+ Patient) !it$ $ pe"ten)i%e c"i)e) a"e 3e)t t"eate# in an ICU !it$ tit"ata3/e IV $ poten)i%e agent)+ Se%e"a/ "api#5acting IV anti$ pe"ten)i%e agent) a"e a%ai/a3/e.1eno/#opam.e2pe"imenta/ )t(#ie) $a%e #emon)t"ate# t$at /a3eta/o/ #oe) not a//e%iate cocaine5in#(ce# co"ona" %a)ocon)t"iction+*>B La3eta/o/ $a) 3een "epo"te# to $a%e a $ pe"ten)i%e "e)pon)e in patient) !it$ p$eoc$"omoc toma+*>* Cont"o/ o1 BP in t$e)e patient) i) 3e)t ac$ie%e# !it$ nica"#ipine.nica"#ipinean# )o#i(m nit"op"())i#e+ 9$i/e nit"op"())i#e i) common/ ()e# to t"eat )e%e"e $ pe"ten)ionit i) an e2t"eme/ to2ic #"(g t$at )$o(/# 3e ()e# on/ in "a"e ci"c(m)tance)+ P"e%io() SectionNe2t Section Vie! t$i) ta3/eN • In t$i) !in#o! • In a ne! !in#o! Ta3/e *+ C/a))i1ication o1 P"eec/amp)iaS Vie! t$i) ta3/eN • In t$i) !in#o! • In a ne! !in#o! .e)mo/o/.

*AAA+ .+ H pe"ten)i%e Eme"gencie) Vie! /a"ge" %e")ionN • In t$i) page • In a ne! !in#o! • Do!n/oa# a) Po!e"Point S/i#e Fig("e *+ Ce"e3"a/ a(to"eg(/ation in no"ma/ an# $ pe"ten)i%e patient)+ Vie! t$i) ta3/eN • In t$i) !in#o! • In a ne! !in#o! Ta3/e .+ Do)age) o1 IV Anti$ pe"ten)i%e Me#ication) Vie! t$i) ta3/eN • In t$i) !in#o! • In a ne! !in#o! Ta3/e <+ Recommen#e# Anti$ pe"ten)i%e Agent) 1o" H pe"ten)i%e C"i)e) P"e%io() SectionNe2t Section (ootnotes • A33"e%iation)N ACE T angioten)in5con%e"ting en4 meF CBF T ce"e3"a/ 3/oo# 1/o!F DA T #opamine • o Accepte# Decem3e" ..Ta3/e .

+m / *u)lic Health 1066#46.<*. *H Hyperten i(e emergencie and urgencie . / 7en $ntern Med 1066#2. recognition.<<> 2. Vla e .*AAA+ P"e%io() Section -eferences 1. 8B >Hyperten i(e emergency?< a u eful diagno tic category. . .an# T"eatment o1 Hig$ B/oo# P"e))("e+ A"c$ Inte"n Me# *AA?F *=?N. ↵ Fergu on. ↵ T$e )i2t$ "epo"t o1 t$e . ↵ 8euler. /+M+ 1069#3::. 7/ Hyperten i(e emergencie and urgencie < definition.oint Nationa/ Committee o1 P"e%ention. /+M+ 1001#399. 8'.paril.DetectionE%a/(ation. /B.(/ A.932593= FREE F(// Te2t 7. ↵ Calhoun. and management..9=54= Me#/ineISI 6. /r Management of hyperten i(e cri e . ↵ 7ifford.R .630562: A3)t"act 4. ↵ .191451912 C"o))Re1Me#/ineISI 5.114451162 Me#/ineISI 3. Magarian. D+. 8. ↵ Hic&ler.o Recei%e# .. % !reatment of hyperten i(e cri i .ngl / Med 1001#232.

/@/. B.1605101 10. Vidt.=6C5:1C C"o))Re1Me#/ine 13. % Hyperten i(e emergency< ca e criteria. %hea. Bancet 1002#2=1. C'7 *re5eclamp ia< more than pregnancy5induced hyperten ion. ↵ .oint Nationa/ Committee 1o" t$e Detection.E%a/(ation an# T"eatment o1 Hig$ B/oo# P"e))("eN t$e *A@< "epo"t+ A"c$ Inte"n Me# *A@<F **<N*B<=R*B=? 15.7arcia.92959=1 A3)t"actHFREE F(// Te2t 11. ↵ . Drug 1064#2=. -ephron 1064#=4( uppl 1).1==451=:= C"o))Re1Me#/ineISI 12. +m / *u)lic Health 1066#46. -M !reatment of hyperten i(e emergencie and urgencie . Hyperten i(e emergencie . D7 Current management of hyperten i(e emergencie ..H HoC hould Ce treat a hyperten i(e emergencyD +m / Cardiol 1060#92. ociodemographic profile. ↵ 8o)ert ..aplan. ↵ Bertel. /M. Fromm.2425246 Me#/ine 14.:15:9 9. /r Hyperten i(e cri e < the need for urgent management. . ↵ Bennett. ↵ 8ahn. MarA. /. 8edman. . *o tgrad Med 1010#00. and pre(iou care of 111 ca e . ↵ . Heart Di %tro&e 1003#1. ↵ Varon.3925346 Me#/ineISI 8. -M. 8.

↵ %mith. Br / +nae th 104:#=4. . ↵ . CB. M. Cith intra(enou nicardipine hydrochloride.1924519=2 Me#/ineISI 16. et al 8eport of the Canadian Hyperten ion %ociety Con en u Conference< 2. M. Burge . ↵ Vidt. randomiEed compari on )etCeen intra(enou nicardipine and odium nitropru ide. et al *o toperati(e hyperten ion< a pro pecti(e. ↵ Mc8ae.4=05494 Me#/ineISI 19. BH Hyperten ion in the immediate po toperati(e period.0035111= 23.9=159=4 22. F / Med 100:#66.1115119 21. Cooperman. -+. +m Heart / 1069#111. ↵ 7al. B8. Med Clin -orth +m 1069#41. /. D7 Current concept in treatment of hyperten i(e emergencie . dou)le5)lind trial. et al *o toperati(e hyperten ion< a multicenter. ↵ *otter. ↵ Halpern.Halpern. +ngiology 1001#=1(11 pt 3)... C. 7old)erg.331533: C"o))Re1Me#/ineISI 20. -+. C. Bie) on. *o tgrad Med 1011#60.13=:513:= A3)t"act 18. .ra&off. FloCer. randomiEed. *8 Hyperten i(e cri i . !/. BeBorier. /F Malignant hyperten ion in the elderly. Control of hyperten i(e emergencie . .4154= A3)t"actHFREE F(// Te2t 17. place)o5controlled. pro pecti(e. 8einhardt. Can Med + oc / 1004#1:4. *harmacologic treatment of hyperten i(e di order in pregnancy. B'. ↵ 8ey. -eely. +licea. 8*/. Crit Care Med 1003#31.

arp. Br / +nae th 106=#:9. et al *athogene i of paroAy mal hyperten ion de(eloping during and after coronary )ypa urgery< a tudy of hemodynamic and humoral factor . +7 *athophy iological e(ent leading to the end5organ effect of acute hyperten ion.:145:11 28.411543= FREE F(// Te2t 24. /7. 8. B. BM *reeclamp ia5eclamp ia.113151133 29. ↵ 8eed.*ry 58ro)ert .le en.::05:9: C"o))Re1Me#/ineISI 27. 8e(e . ↵ %trandgaard.. +nder on.+BC of )lood pre ure reduction< emergency reduction. %. D . ↵ +ult. '7. hyperten ion in pregnancy. %&inhoG. 8B. /.. 'right. .. ↵ Bannan. BM/ 1061#361. +m / Cardiol 1061#=9.llrodt. M/. ↵ 'allach. . B!.merg Med 106:#2(9 uppl). Curr *ro)l . .1151: C"o))Re1Me#/ineISI 26. MarA. ↵ . . C +ne the ia and hyperten ion. +m Heart / 1069#111. D7.ffect of rapid )lood pre ure reduction on cere)ral )lood floC.3395336 C"o))Re1Me#/ineISI 31. Conen. ↵ %i)ai. +m / Med 1064#63.) tet 7ynecol $nfert 1001#12. BM/ 1042#1. ↵ Bertel. . Bee(er . .25=: 25.ffect of antihyperten i(e treatment on cere)ral perfu ion. 8/ . et al +utoregulation of )rain circulation in e(ere arterial hyperten ion. and hyperten ion in the elderly. +m / .30529 Me#/ineISI 30.

↵ Fromm.=925=42 . HaC&in . ↵ 7ro man. F7.0345023 Me#/ineISI 36. M7 +d(ance in the acute therapy of hyperten ion. 7i)) . ↵ Co$n LH+ Ao"tic #i))ectionN ne! a)pect) o1 #iagno)i) an# t"eatment+ Ho)p P"act 6O11 E#7 *AA<F .192151921 C"o))Re1Me#/ineISI 34. BM.03509 33.. ↵ Hiegler. / .Chen. et al +cute thoracic aortic di ection< the )a ic . Varon. /. ↵ %chillinger.6:05694 C"o))Re1Me#/ine 32. /..ngl / Med 1003#239. !.41564 C"o))Re1Me#/ine 35. *o tgrad Med 1001#02. 7rodEic&i. D' !reating hyperten i(e emergencie < controlled reduction of )lood pre ure and protection of target organ . .. et al %hould a moratorium )e placed on u)lingual nifedipine cap ule gi(en for hyperten i(e emergencie and p eudoemergencie D /+M+ 1009#349. . / . 'en&er. Bindheimer. Carr.merg Med 1064#:. Me erli. 8. . D -ifedipine in hyperten i(e emergencie < a pro pecti(e tudy. / . B Conge ti(e heart failure and pulmonary edema for the emergency phy ician. FH. Crit Care Med 1003#31.C. ↵ Cunningham. .merg Med 1004#1:.. ↵ *ri ant. MD Hyperten ion in pregnancy.merg Med 100:#12. Varon.AN<?R=> 37. ++.123651221 A3)t"act 38.

12925129: Me#/ine 45. CheCing nifedipine to rapidly treat hyperten ion. F. ↵ %pah.. nifedipine. Danhof. *.rtur&.Emenoglu.. Burggraaf. C %ingle5do e u)lingual nifedipine a the only treatment in hyperten i(e urgencie and emergencie . / Cardio(a c *harmacol 1066#13( uppl =). ↵ . B. +rch $ntern Med 106=#1==. ↵ 7onEaleE5Carmona. . et al . M. ↵ Haft. %.% -ifedipine and hypoten ion IletterJ. /. et al -egligi)le u)lingual a) orption of nifedipine. ↵ (an Harten.%1:=5%1:9 40. $)arra5*ereE.om uoglu. Bancet 1064#3. Channer. . 7ro er. . $nt / Cardiol 1003#2=. '. /erGe 5%ancheE. /$. M.=445=61 42.C"o))Re1Me#/ine 39. +ngiology 1001#=3. VM.492549= 46. Bitterer.om uoglu. ↵ Di&er.0165012 41. . . Bancet 1001#226. .ral nifedipine in the treatment of hyperten i(e cri e in patient Cith hyperten i(e encephalopathy. . %%. 7 $ u)lingual nifedipine admini tration uperior to oral admini tration in the acti(e treatment of hyperten ionD +ngiology 1003#=2.D !reatment of hyperten i(e urgencie and emergencie Cith nitrendipine. C. ↵ 'oodman ey.32:4532:0 C"o))Re1Me#/ineISI 44. +&gun. and clonidine< effect on )lood pre ure and heart rate.3445363 C"o))Re1Me#/ineISI 43. ↵ .

/ Clin *harmacol 1069#39. Clinical pharmacology of pota ium channel opener . . *harmacol !oAicol 1003#41. et al . Huy man . et al $nfluence of (olume replacement Cith different H.40:5400 Me#/ineISI 51.205=2 A3)t"act 53. D.ho. MC !he comparati(e effect of clonidine hydrochloride and nifedipine in the treatment of hyperten i(e cri e . /. ↵ Hou ton. 8.%5 olution on microcirculatory )lood floC in cardiac urgery. de HCaan. et al Cere)ral )lood floC during the acute therapy of e(ere hyperten ion Cith oral clonidine. DD. F*.*eter . ↵ +nder on. 7erlag. ↵ . ↵ 7reene. F!. B *rolonged F! inter(al and (entricular fi)rillation after treatment Cith u)lingual nifedipine for malignant hyperten ion IletterJ. ↵ !hien. /. et al DiaEoAide infu ion in e(ere hyperten ion and hyperten i(e cri i . . Cer(en&a. +cta +nae the iol %cand 100=#26. C. ..3025309 C"o))Re1Me#/ineISI 50. ↵ %trau . $. 8apin.nalaprilat in hyperten i(e emergencie .1:351:0 49.399:53999 C"o))Re1Me#/ineISI 47. Vlaha&o . Hic&mann. +m / .. ↵ Boldt. *7.3==53:= Me#/ineISI 52. !+. Clin *harmacol !her 1040#3:. +rch $ntern Med 1004#1:4.merg Med 1001#6. 7retler. B. +m Fam *hy ician 1066#11:(1 pt 1). 7a(ra . C%.=235=26 Me#/ineISI 48.

D/. ↵ 8utledge. Mangano. Ferraro. in hyperten i(e cri e . 88. Caregaro. /C. ↵ Ceyhan. Binder.araa lan. M. +rch $ntern Med 1001#1:1. $. et al . ↵ +ngeli. et al $mpact of the renin5angioten in5aldo terone y tem on )lood pre ure re pon e to intra(enou enalaprilat in patient Cith hyperten i(e cri e . @. M!. M. et al Compari on of effect of enalapril and captopril on erum pota ium concentration in the treatment of malignant hyperten ion. !. . ↵ Hir chl.1445162 C"o))Re1Me#/ineISI 58. B. +yer . ! u&a hima. B. /. et al Compari on of u)lingual captopril and nifedipine in immediate treatment of hyperten i(e emergencie < a randomiEed. Fulantelli. Cardio(a c Drug !her 1003#9.:115:31 . +. 8..119351194 C"o))Re1Me#/ineISI 57.nalaprilat. an intra(enou angioten in5 con(erting enEyme inhi)itor. +. *. et al !reatment of malignant hyperten ion Cith an angioten in con(erting enEyme inhi)itor. /pn / *harmacol 1001#:3. +m / Cardiol 1066#93. ↵ ! uchiha hi. / Hum Hyperten 1004#11.Di*ette. ↵ Cottone.9465963 C"o))Re1Me#/ineISI 55. et al Compari on of u)lingual captopril and u)lingual nifedipine in hyperten i(e emergencie .100531= Me#/ineISI 54. Clin *harmacol !her 106:#26.(an . CaymaE. %. Da(id on. Clin !her 1060#11.ffect of intra(enou enalaprilat in moderate and e(ere y temic hyperten ion. . +)e.=0:5=06 C"o))Re1Me#/ineISI 59. MM. et al . . Chie a. M+. ingle5 )lind clinical trial. C.1605 102 Me#/ine 56. Bur.

2065=12 A3)t"actHFREE F(// Te2t 61.03:5030 C"o))Re1Me#/ineISI 65. ↵ BoCenthal.Me#/ineISI 60. Fuon. /8. . +ne the iology 1006#60. 'inter . 8/.V.B. et al Clinical pharmacology. *orter. Michel on. 7orcEyn &i. et al Beta5adrenergic )loc&ade accelerate con(er ion of po toperati(e upra(entricular tachyarrhythmia . ↵ Bal er. ↵ 8eynold . . 7er ony. ↵ *latia. . molol (er u (erapamil in the acute treatment of atrial fi)rillation or atrial flutter.:635:01 Me#/ineISI 66. et al . +m / Cardiol 1060#92.11:3511:0 C"o))Re1Me#/ineISI 64. ↵ %merling. /. +m / Cardiol 106:#:9.136651301 Me#/ineISI . ↵ 7ray.+25+1= A3)t"act 63. molol for e(ere hyperten ion folloCing repair of aortic coarctation.+. Clin *harm 1066#4.1=F516F C"o))Re1Me#/ine 62. *orterfield. C@ *harmacology and pharmaco&inetic of e molol. D!. / Clin *harmacol 1069#39( uppl +). ↵ %tumpf. %D. BD. pharmacodynamic and interaction Cith e molol. 8/ Managing critically ill patient Cith e molol< an ultra hort5acting )eta5 adrenergic )loc&er. 8D. +. Che t 1066#02. 'M . 8%. %ari . MartineE. /B Drug therapy of hyperten i(e cri e . Crit Care Med 1001#16..

+-. +m / Cardiol 1064#:0. Bateman. ↵ 7ray. HaleC &i. +m Heart / 1003#13=. +m Heart / 1002#0:. . M.6645601 C"o))Re1Me#/ineISI 69. +nn *harmacother 100=#36.=0F5:9F C"o))Re1Me#/ine 68. et al Ba)etalol and e molol in the control of hyperten ion after intracranial urgery.4115412 A3)t"act 71. Bateman.=165=32 C"o))Re1Me#/ineISI 73. Blac&. ↵ %hi. 8/. B%.lliott. / Biol Chem 100=#390. ↵ 7ray. ↵ !i)eri. et al %electi(e dopamine51 receptor agoni t augment regional myocardial )lood floC< compari on of fenoldopam and dopamine.1915196 . 'B Fenoldopam. %. +m / Cardiol 106:#:9. Bra(ette. %M. -H. CEer.3403:534021 A3)t"actHFREE F(// Te2t 72. D+.96541 A3)t"actHFREE F(// Te2t 70. et al %afety of e molol in patient Cith acute myocardial infarction treated Cith throm)olytic therapy Cho had relati(e contraindication to )eta5)loc&er therapy. +. 'hite. B. ↵ %hu terman. Mohiuddin. et al Compari on of e molol and nitropru ide for acute po t5cardiac urgical hyperten ion. ↵ MuEEi.67. Hilleman. et al K e of e molol in hyperten ion after cardiac urgery. '/. D. !/. B%. !M. ↵ Moo . CEer. Caron. !M. +ne th +nalg 1001#41. )ut not nitropru ide. M7 High agoni t5independent acti(ity i a di tingui hing feature of the dopamine D1B receptor u)type.. Bo a o. impro(e renal function in e(erely hyperten i(e patient Cith impaired renal function. @. 8/.

Crit Care Med 1001#16. . +nder on.0415044 A3)t"actHFREE F(// Te2t 80.111651132 A3)t"act 78.9159= Me#/ineISI 76. et al Hemodynamic profile of intra(enou fenoldopam in patient Cith hyperten i(e cri i . et al 8enal and hemodynamic effect of intra(enou fenoldopam (er u nitropru ide in e(ere hyperten ion. Mar&ham. '/. %. 8adford. 8. 8utherford. et al 8andomiEed. ↵ 'hite. ↵ .M. / +m Coll Cardiol 1066#11. ↵ Bodmann. .74.merg Med 100:#3. et al %electi(e dopamine51 agoni t therapy in e(ere hyperten ion< effect of intra(enou fenoldopam. Clin $n(e t 1002#43. ↵ *anace&. 'B. M/. B. 88. FM. -el on. et al + e ment of intra(enou fenoldopam me ylate in the management of e(ere y temic hyperten ion. 'e)er. Circulation 1001#61. .F.+. 'F. Dun)ar.lliott. 8-.%. Clemen . 7onEaleE.92=59:1 Me#/ineISI 75. +cad . Drug 1004#:=. BM. ↵ Brogden. + Fenoldopam< a re(ieC of it pharmacodynamic and pharmaco&inetic propertie and intra(enou clinical potential in the management of hyperten i(e urgencie and emergencie . BednarcEy&.0:0509: Me#/ineISI 79. ↵ .:135:1= Me#/ineISI 77. ↵ Munger. pro pecti(e trial of fenoldopam ( odium nitropru ide in the treatment of acute e(ere hyperten ion< Fenoldopam %tudy 7roup. . M+. !ro ter.

MM. ↵ MarA. ↵ *earce. ↵ 8ei in. /. et al $ntra(enou fenoldopam (er u odium nitropru ide in patient Cith e(ere hyperten ion. C/. $nt / Clin *harmacol !her !oAicol 1061#10. M. . /D +drenoreceptor and renal function. %.$:05$93 82. ↵ .anot. ↵ 'allin. /. +rch $ntern Med 1060#1=0. Br / Clin *harmacol 1040#6( uppl 3). B*. et al *harmaco&inetic of la)etalol in healthy (olunteer .'hite. Drug 106=#36( uppl 3). +m Heart / 1001#110(3 pt 3). Clar&. 8eid.leimola. Halley. ↵ 7old)erg. Haemodynamic effect of la)etalol. 'B. *7. * *harmacology of com)ined alpha5)eta5)loc&ade< $$.2:5:1 83.641564= C"o))Re1Me#/ineISI 81.1415146 87.==95=:1 C"o))Re1Me#/ineISI 85. -guyen. 'allin. D% Ba)etalol infu ion in acute myocardial infarction Cith y temic hyperten ion. et al -icardipine (er u place)o for the treatment of po toperati(e hyperten ion. /D Ba)etalol and other agent that )loc& )oth alpha5 and )eta5 adrenergic receptor . ↵ . H.:0590 Me#/ineISI 86.=15== Me#/ine 84.. %. Hyperten ion 1001#1:(3 uppl).. !. Cle(e Clin / Med 100=#91. /o eph. Huth. Comparati(e renal effect of intra(enou admini tration of fenoldopam me ylate and odium nitropru ide in patient Cith e(ere hyperten ion. / Clin Hyperten 106:#1. +llonen. . ↵ Bund5/ohan en.322%5326% Me#/ine 88.

// $ntra(enou la)etalol in e(ere hyperten ion. /D $ntra(enou nicardipine hydrochloride< treatment of patient Cith e(ere hyperten ion. 'allin. ↵ $V -icardipine %tudy 7roup.1=510 ISI 94.2==52:: C"o))Re1Me#/ine 92. Bancet 104:#3. oAygen meta)oli m and autoregulation in healthy human . /D. 7%. ↵ !urlapaty. Bien(enu.l en. *. et al . BB. 8. Vary.. ↵ 'allin. Che t 1001#00.fficacy and afety of intra(enou nicardipine in the control of po toperati(e hyperten ion. D/. . +m / Med 1062#4:. +m Heart / 1001#110(3 pt 3). et al -icardipine in e(ere hyperten ion< oral therapy folloCing intra(enou treatment.11025110= 91. ↵ 'il on.. .:15 := A3)t"actHFREE F(// Te2t 89. Bar en. -D. et al $ntra(enou la)etalol in the treatment of e(ere hyperten ion and hyperten i(e emergencie . $nt / Clin *harmacol !her 1001#36.=2=5=24 C"o))Re1Me#/ineISI 95. Vlacha&i . ↵ 8o ei. F%. /+ -icardipine.. a neC intra(enou calcium antagoni t< a re(ieC of it pharmacology.0:5113 C"o))Re1Me#/ineISI 90.2025206 A3)t"actHFREE F(// Te2t 93. pharmaco&inetic . . !ru t.aplan. ↵ .%.ffect of la)etalol on cere)ral )lood floC. Coo&. %(end en. ↵ 'allin. and perioperati(e application . . *M. / Cardiothorac +ne th 1060#2. . /D. BroCn. Br / +nae th 100:#4:.+.

fficacy of u)lingual nifedipine in the relief of immediate po t5operati(e hyperten ion. H. + -icardipine in model of myocardial infarction. 7old)erg.36=5 364 . Coo&. Crit Care Med 1001#16. '@. 7a ter. 7D. et al +cute pharmaco&inetic and hemodynamic effect of intra(enou )olu do ing of nicardipine. ↵ +lp . F!. !+. 7%. et al -icardipine infu ion for po toperati(e hyperten ion after urgery of the head and nec&. %luiter. et al Compari on of u)lingual captopril.111:51110 98. !hien. D7. Bin.. ↵ Clifton. /%. $ndian / Med 8e 1064#69. ↵ Clifton. et al $ntra(enou nicardipine in e(ere y temic hyperten ion. 77. 77. Batra. /B. ↵ Huy man . H ..93=5936 Me#/ineISI 102. M. /D $ntra(enou nicardipine< an effecti(e neC agent for the treatment of e(ere hyperten ion. ↵ *uri. et al +cute treatment of hyperten i(e cri i Cith nifedipine. %laden..Halpern. %ingh. -eutel. %7.43:5434 Me#/ineISI 101.0:150:: Me#/ineISI 96. C. Calder. -+. %hiao. -ephron 1002#9:. %B. 'allin. nifedipine and praEo in in hyperten i(e emergencie during hemodialy i . 'il on. Br / Clin *harmacol 1062#19. Bien(enu. ↵ 'u.=265 ==3 C"o))Re1Me#/ineISI 100. 8-.30%5=0% 99. +m / Cardiol 1060#9=. Br / Clin *harmacol 106:#31( uppl 1). +ngiology 1001#=1(11 pt 3). ↵ Cheung. +m Heart / 1001#110(3 pt 3). /M.19H516H C"o))Re1Me#/ine 97. B/. @.

4456: Me#/ineISI 108. +m / Cardiol 1002#43.Me#/ineISI 103. / Cardio(a c *harmacol 1062#:.0C512C C"o))Re1Me#/ine 107. ↵ *a ch.16=3516=: FREE F(// Te2t 109. !. 7% Va odilator in the inten i(e care unit. ↵ Franci . ↵ Friederich.fficacy and afety of nifedipine (er u magne ium ulphate in the management of preterm la)or< a randomiEed tudy.245=2 . ↵ 7loc&. 8 -itropru ide5related cyanide poi oning< time (long pa t due) for urgent. +.1:35193 A3)t"act 106. +ne th +nalg 100:#61. %chulE. cere)ral )lood floC. autoregulation and car)on dioAide5reacti(ity )y hypoten i(e agent in )a)oon Cith intracranial hyperten ion. C. /F %odium nitropru ide< tCenty year and counting. +m Heart / 1001#131(9 pt 1). McCauley. ↵ 8o)in. effecti(e inter(ention . Che t 1003#113. V. Buttinger. !. /B. . Morale . Hoppen hau er.D. ↵ Fung. et al +lteration of intracranial pre ure. +m / .164:51646 C"o))Re1Me#/ineISI 105.091509= Me#/ineISI 104. /+. 7 -itropru ide5induced formation of cyanide and it detoAication Cith thio ulphate during deli)erate hypoten ion.) tet 7ynecol 1002#190. '/ . ButterCorth. ↵ Hartmann. 8ommel. -eurochirurgia 1060#23. HB Clinical pharmacology of organic nitrate .

%+ -itropru ide5induced intracranial hyperten ion IletterJ.3125311 C"o))Re1Me#/ine 113. Bach. Francio a. '8. +cta -eurochir 1061#:6. H . MendoEa. /-.394053961 C"o))Re1Me#/ineISI 112. ↵ Mann.ffect of intra5arterial odium nitropru ide on intracranial pre ure and cere)ral autoregulation.4235426 A3)t"actHFREE F(// Te2t 115.merg Med Clin -orth +m 100:#12.10534 .. +. Holman. Franci .ondo. et al . !. et al %odium nitropru ide and intracranial pre ure.3215324 Me#/ine 111. /M %odium nitropru ide5induced cyanide intoAication and pre(ention Cith odium thio ulphate prophylaAi . Broc&. Cohn. M.ffect of hort5term infu ion of odium nitropru ide on mortality rate in acute myocardial infarction complicated )y left (entricular failure< re ult of a Veteran +dmini tration cooperati(e tudy. Bracali. ↵ . 7%. BB. 8eEni&. ↵ Murphy. *F. V. Hanghi. F.ngl / Med 1063#219. . C.11305112: A3)t"act 116. ↵ +nile. C Hyperten i(e emergencie . Circulation 1046#:4. ↵ Cohn. +m / Crit Care 1003#3. 7ue t. !. et al .Me#/ine 110. .04251114 Me#/ine 114. /pn Heart / 106=#3:. /+.ffect of nitropru ide on regional myocardial )lood floC in coronary artery di ea e< re ult in 3: patient and compari on Cith nitroglycerin. ↵ 7ri Cold. V+. /+M+ 1061#3=9. ↵ Hall.

. 8%.Ap !her 1004#363. H. ↵ 7o))el.H . *. +.191151914 A3)t"actHFREE F(// Te2t 119. DB.ong. Beong. . FuGimori. @. 7!.214523= Me#/ine 118. Chan. . 8en. Chan. +M. M.totoAicity of odium nitropru ide. @a uda.. */ $n(ol(ement of nitric oAide in nitropru ide5induced hepatocyte cytotoAicity.LBrien. '/. ↵ -i&nahad.112151120 C"o))Re1Me#/ineISI 120. Chemo phere 1004#2=. !. H. et al CytotoAic effect of odium nitropru ide on *C13 cell .1905146 C"o))Re1Me#/ineISI . *H -itric oAide5 and uperoAide5mediated toAicity in cere)ral endothelial cell . ↵ 8auhala. ↵ 8uan. ↵ $Eumi.haldi. Biochem *harmacol 1009#:1. . ↵ -a&amura. Clifford. et al +pparent role of hydroAyl radical in oAidati(e )rain inGury induced )y odium nitropru ide. -uttall.119:51142 C"o))Re1Me#/ineISI 122. / *harmacol .117.*.Ap -eurol 1002#131. %.lectrophy iological and morphological e(aluation of the acute ototoAicity of odium nitropru ide. @eoh. Mohana&umar. et al -eurotoAic effect of odium nitropru ide in rat hippocampal lice . BenE. +B .33521 C"o))Re1Me#/ineISI 123. Hear 8e 1004#11=. Free 8adic Biol Med 1006#3=. . @. !@.1=532 C"o))Re1Me#/ineISI 121. ↵ . Hear 8e 1009#00.

Clin $n(e t 1003#41. ↵ %chroeder. ↵ . et al Duration of hydralaEine action in hyperten ion.124. $ raili.enedi.61=5611 Me#/ineISI 128. !M.4905446 Me#/ineISI 130. C/. 8 . /B. Br / +nae th 1049#=6. *V. Mc-ay. Clin *harmacol !her 1061#36. 'D. Cole. *. ↵ Budden.9435942 127. */ Cyanide and thiocyanate concentration folloCing odium nitropru ide infu ion in man.LMalley. (on Mengden. ↵ .116:51166 Me#/ineISI 126. Hace t. %imp on. Clin *harmacol !her 104:#16. Clin *harmacol !her 1061#36. %hepherd.:615:69 Me#/ineISI 129. *+.. /B. et al HydralaEine &inetic after ingle and repeated oral do e . HH. +M. Budden. ↵ 8eece. H+ .ffect on hyperten ion of ulfhydryl and hydraEine compound . et al HydralaEine &inetic in hyperten i(e patient after intra(enou admini tration. . H/. ↵ Ve ey.9:159:0 A3)t"actHFREE F(// Te2t 125. %egal. . / Clin $n(e t 10:1#21. Clin *harmacol !her 1061#36. $. ↵ %hepherd. CoEamani .42954=3 Me#/ineISI 131. ↵ Bu mann.inetic of hydralaEine and it main meta)olite in loC and fa t acetylator . +M. !M. /B. et al Compari on of nitroglycerin Cith nifedipine in patient Cith hyperten i(e cri i or e(ere hyperten ion. Mc-ay.

*erry. *roc %oc . . ↵ 7ru)).3415346 Me#/ineISI 137. %irio. 8 $ntra(enou la)etalol in acute aortic di ection. D. + %pontaneou re olution of a di ection of the de cending aorta after medical treatment Cith a )eta )loc&er and a calcium antagoni t. H7. %a&ai.utcome of medically treated %tanford type B aortic di ection.:495:40 C"o))Re1Me#/ine 132. . ↵ . +.64: FREE F(// Te2t 133. M*. . B. /+M+ 1064#3:6. ↵ Bor t.LConnor. Heli .113511: C"o))Re1Me#/ine 135.6356= A3)t"actHFREE F(// Te2t 134.Moore5/one .46540 C"o))Re1Me#/ineISI 136. 8% !he natural hi tory of thoracic aortic aneury m di ea e< an o(er(ieC. BM/ 100:#211. / %urgical treatment of thoracic aortic aneury m . / Card %urg 1004#13(3 uppl). !a)aya hi. /r 8adioautographic localiEation of hydralaEine515C51= in arterial Call . ↵ afer than . !. Bon er. +d( Card %urg 1002#=. C. M. ↵ $guchi. ↵ Ho hino. /pn Circ / 1006#93. ↵ *itt. Baa . Buntley. B*. Br Heart / 1064#:6.hmae.=4564 Me#/ine 138. HM. /B +cute di ection of the thoracic aorta< e molol i and a effecti(e a la)etalol IletterJ.Ap Biol Med 1099#133.

/. BB Blood pre ure after tro&e. Brott. /D. 8M. H*. /+M+ 1061#3=9.1:6651911 FREE F(// Te2t 143.1:3251:3= FREE F(// Te2t 141. BM/ 100=#216. %pecial re u citation ituation < tro&e /+M+ 1003#396. 7ray.=165=1: Me#/ineISI 144. +merican Heart + ociation.99596 C"o))Re1Me#/ineISI 140. ↵ +dam . Circulation 100=#01. et al 7uideline for the management of patient Cith acute i chemic tro&e< a tatement for the healthcare profe ional from a pecial Criting group of the tro&e council.'allace. 7ray. ↵ Ba(in. Be(y. CroCell. * Management of hyperten ion in patient Cith acute tro&e..mergency Cardiac Care Committee.00151111 Me#/ineISI 145. /. ↵ .LConnell. Drug +ging 1009#6. and %u)committee . MM 7uideline for the drug treatment of hyperten i(e cri e . ↵ . !7.LConnell. +merican Heart + ociation guideline for cardiopulmonary re u citation and emergency cardiac care< $V. Drug 100:#:1. ↵ Hir chl. ↵ . +rch $ntern Med 1069#1=9. C% !reatment of po t5 tro&e hyperten ion< a practical guide. ↵ . C !reating hyperten ion after tro&e.33=3533== C"o))Re1Me#/ineISI 142.314453161 A3)t"act 139.

FB !he fetal outcome in a randomiEed dou)le5 )lind controlled trial of la)etalol (er u place)o in pregnancy5induced hyperten ion. Car)onne. *ip&in. . . et al + comparati(e trial of la)etalol and hydralaEine in the acute management of e(ere hyperten ion complicating pregnancy. Br / .09=5096 Me#/ineISI 149. BliCi e. BliCi e. et al 8ate of 3=5hour )lood pre ure decline and mortality after pontaneou intracere)ral hemorrhage< a retro pecti(e analy i Cith a random effect regre ion model. %ymond . .265=2 Me#/ineISI 150. Br / . BM.. ↵ Buca . C/. DB./. 7onEaleE. 'C. .ngl / Med 100:#222. / + randomi ed controlled trial of intra(enou magne ium ulphate (er u place)o in the management of Comen Cith e(ere pre5 eclamp ia. %ymond .2365222 Me#/ineISI 151.2:=52:0 . -7.) tet 7ynaecol 1003#00. C/. . +$. Br / . Be(eno.) tet 7ynecol 1064#41(2 pt 1). ↵ /annet. .) tet 7ynecol 100=#6=.M + randomi ed place)o controlled trial of la)etalol in the treatment of mild to moderate pregnancy induced hyperten ion. .Fure hi. ↵ CoetEee. /.) tet 7ynaecol 1006#11:. B.=615=6: C"o))Re1Me#/ineISI 146. Cunningham. et al -icardipine (er u metoprolol in the treatment of hyperten ion during pregnancy< a randomiEed comparati(e trial. .M. %e))an. ↵ *ic&le . +nthony. +8.. D. Broughton.) tet 7ynaecol 1060#09. F7 + compari on of magne ium ulfate Cith phenytoin for the pre(ention of eclamp ia.2115212 Me#/ineISI 147. ↵ Ma)ie.311531: A3)t"actHFREE F(// Te2t 148. ↵ *ic&le ./. Crit Care Med 1000#34. Dommi e. %i)ai. *F. M/.

8+.merg Med 1001#10. et al Compari on of la)etalol.016501= Me#/ineISI 153.. and haloperidol for the treatment of cocaine toAicity in a Cine mode Ia) tractJ.3635362 C"o))Re1Me#/ineISI 157. /annet.6045012 154. ↵ %pi(ey.merg Med 1066#14. +nn . M/. 8. recognition.. +nn $ntern Med 1001#113. and management. +nn .139451343 FREE F(// Te2t 156. . . !ou)oul.=945=96 159. diaEepam.merg Med 1064#19. /. *rog Cardio(a c Di 1004#=1. ↵ 7ay. /M. /. 8+. .) tet 7ynecol 1002#61. %/.32: 158.ir&patric&. et al -icardipine treatment of hyperten ion during pregnancy. 78. D. Flore . +nn . C. . */ Ba)etalol treatment of cocaine toAicity IletterJ. B. Hic& . ↵ Car)onne.Me#/ineISI 152. Cigarroa. ↵ . 87. et al Cocaine5induced myocardial i chemia and infarction< pathophy iology. ↵ Hollander. Cigarroa. !he management of cocaine5a ociated myocardial i chemia. Boper. Mariani.D. %choff tall. ↵ Du en)erry. '8. Bange. . ↵ Bange. ↵ *itt . et al *otentiation of cocaine5induced coronary (a ocon triction )y )eta5adrenergic )loc&ade.9:549 C"o))Re1Me#/ineISI 155.ngl / Med 100:#222. 'H.+ !he u e of la)etalol in the management of cocaine cri i .

↵ Buhe hi. 'illard.Catra(a . ↵ Boehrer. '+. /. /D. /..9165911 C"o))Re1Me#/ineISI 161.2:152:9 FREE F(// Te2t 160. +/. / *harmacol . BD. *ohl. ↵ Moore. Hilli . 8ee . Carter.ngl / Med 1003#234.. 7. BrouCer. /D. et al . /. %. BH. ↵ -egu . $' +cute cocaine intoAication in the con ciou dog< tudie on the mechani m of lethality.291 Me#/ineISI 165.. +m / Cardiol 100=#42..Ap !her 1061#314. 8% K e of phentolamine for cocaine5induced myocardial i chemia IletterJ. 'ater . Hoffman. ↵ Brigg . +/. 7. ↵ Hollander.11=:511=9 162. 8%.4105431 C"o))Re1Me#/ineISI 164.ffect of B5type calcium channel modulator on timulant5induced hyperacti(ity. 7. ↵ . %anger. +m / Med 1002#0=. +m / *hy iol 1009#341(1 pt 1). Moliterno. Hyperten i(e re pon e to la)etalol in phaeochromocytoma IletterJ. et al $nfluence of la)etalol on cocaine5 induced coronary (a ocon triction in human . et al +lle(iation of cocaine5induced coronary (a ocon triction Cith intra(enou (erapamil. .:115:12 C"o))Re1Me#/ineISI 163. Bancet 1046#1. et al $nterleu&in51 receptor antagoni t inhi)it endotoAin fe(er and y temic interleu&in59 induction in the rat. D/. -europharmacology 1002#23. BirtCell. Miller. 'illard. /. -+.015.0: A3)t"actHFREE F(// Te2t 166..

/an&o.129=51241 C"o))Re1Me#/ineISI Articles citing this article • o o o K+ O+ R nnF+ L+ H(g$e)an# B+ Fa/e An Eme"genc Depa"tment App"oac$ to D"(g T"eatment o1 H pe"ten)i%e U"genc an# Eme"genc /ournal of *harmacy *ractice . /.+ 9 De%/inM+ L SetaS+ KanIian# A+ L Some"%i//e Feno/#opam Ve")() Nit"op"())i#e 1o" t$e T"eatment o1 H pe"ten)i%e Eme"genc !he +nnal of *harmacotherapy May 1.HaEgorni&. 311= 31<=315=3= o o o • o o o o A3)t"act F(// Te2t F(// Te2t 6PDF7 . 311= 26<4::54:0 o o A3)t"act F(// Te2t . . 7. et al Bilateral nephrectomy< the )e t. 311: 16<2925249 o o • o o o A3)t"act F(// Te2t 6PDF7 .+ E Ti)#a/eM+ B H(angan# S+ Bo"4ak Ri)k 1acto") 1o" $ pe"ten)i%e c"i)i)N impo"tance o1 o(t5patient 3/oo# p"e))("e cont"o/Fam *ract +ugu t 1. treatment for refractory hyperten ion in hemodialy i patient . +m / Hyperten 1006#11(11 pt 1). )ut often o(erloo&ed. Bie en)ach.cto)er 1..

+ M+ Egan P$a"maco/ogica/ Agent) T$at Di"ect/ Mo#(/ate In)(/in Sec"etion*harmacol. /anuary 1. Crit.+ 9+ Sea"an# P+ Foe2 H pe"ten)ion. Care Med.$ pe"ten)i%e $ea"t #i)ea)e an# pe"iope"ati%e ca"#iac "i)kU#agge"VBr / +nae th +pril 1. 3112 ::<11:5121 o o o • o o A3)t"act F(// Te2t F(// Te2t 6PDF7 A+ POPPAS an# S+ ROUNDS Conge)ti%e Hea"t Fai/("e+m. 311= 03<:415:62 o o o • o A3)t"act F(// Te2t F(// Te2t 6PDF7 C+ Ha""ington Managing H pe"ten)ion in Patient) 9it$ St"okeN A"e Po( P"epa"e# 1o" La3eta/o/ In1()ionWCrit Care -ur e /une 1. 8e pir. 3112 32<21526 o o • o o F(// Te2t F(// Te2t 6PDF7 M+ E+ Do /e an# . March 1. 8e(.o • o o o F(// Te2t 6PDF7 S+ .+ Ho!e//. /. 3113 19:<=56 o o F(// Te2t F(// Te2t 6PDF7 .

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