Case 3

A 66-year-old man presents to the ED with chest pain and acute shortness of breath onset two hours previously. He is known to have ischaemic heart disease and hypertension and is on aspirin, perindopril, atenolol and simvastatin.

On examination he is found to be distressed and dyspnoeic. Observations are as follows: P = 105, BP = 225/130, RR = 35, SaO2 = 89% on air.

He is apyrexial. Heart sounds reveal an added third heart sound. Auscultation of his chest reveals bilateral crepitations to the mid zones. GCS = 15/15.

His ECG is shown here. Chest x-ray reveals evidence of pulmonary oedema.

Click on the ECG to enlarge.

You decide that this man is presenting with a hypertensive emergency.

List five features of this presentation, which, in addition to the elevated blood pressure, indicate a hypertensive emergency.

You decide that, in addition to anti-thrombotic therapy, urgent control of his blood pressure is indicated.

Which of the following drugs are most appropriate as the first line of treatment in this setting?

Select one or more options.