Drugs used to Manage Hypertension
The following drugs are used to manage hypertension in AAD (either singly or in conjunction):
α and β-blocker
|
Drug |
Dose |
Contraindications |
|---|---|---|
|
Labetalol |
0.25 mg/kg (usually 20 mg) as a bolus over 2 min. Further boluses of 20-80 mg are usually required every 10 min once BP controlled a continuous infusion at 2 mg/min. |
Cardiogenic shock, AV block, bradycardia, COPD (relative contraindication) |
β-blockers
|
Drug |
Dose |
Contraindications |
|---|---|---|
|
Esmolol |
250-500 mcg/kg/min loading dose administered over 1 min, followed by maintenance infusion 10-50 mcg/kg/min for 4 min. Repeat loading dose and increase maintenance dose for 4 min if BP remains elevated. |
Cardiogenic shock, AV block and bradycardia |
|
Metoprolol |
Starting dose is normally 5mg injected at a rate of 1-2 mg/min. Repeat doses can be given after 5 min intervals to a total dose of 10-15 mg. |
As above |
Vasodilators (second line agent – should already be on a beta blocker)
|
Drug |
Dose |
Contraindications |
|---|---|---|
|
Glyceryl trinitrate |
2-10 mg/hour infusion – titrate to blood pressure |
Hypotension, hypovolaemia HOCM, aortic stenosis |
|
Sodium nitroprusside |
0.5-1.5 mcg/kg/min infusion – titrate to blood pressure. |
Severe vitamin B12 deficiency, hypotension, hypovolaemia. Beware cyanide toxicity as a side-effect – hyperventilation arrhythmias, severe metabolic acidosis. |
Non-dihydropyridine calcium channel blockers (rarely used – only where β-blockers contraindicated)
|
Drug |
Dose |
Contraindications |
|---|---|---|
|
Verapamil |
Usually 2.5-5mg over 2 minutes initially. A repeat dose can be considered after 15-30 minutes. Total maximum dose is 20-30mg. |
Broad complex tachycardias, 2nd/3rd degree AV block, severe heart failure, sick sinus syndrome, HOCM, Hypotension or shock. |
|
Diltiazem |
0.25mg/kg bolus over 2 minutes (10-20mg is often used initially) followed by continuous IV infusion at 5-15mg/hour. |
As above |