Indications and Administration Details
This table summarises the indications and administration details of parenteral agents used in hypertensive emergencies.
| Agent | Dose | Indications |
|---|---|---|
| Sodium Nitroprusside | Initially 0.5-1.5mcg/kg/min.
Titrate up in increments of 0.5 mcg/kg/min Max up to 8 mcg/kg/min |
Hypertensive encephalopathy
Cardiac ischaemia Cardiac failure/pulmonary oedema Aortic dissection (+ beta blocker) |
| Labetalol | Initial 20-50mg over at least 1 minute. Can be repeated every 5 minutes to a maximum of 200mg OR titrate infusion starting at 2mg/min.
Then infusion 2mg/min, titrated as required |
Stroke syndromes
Hypertensive encephalopathy Aortic dissection Phaeochromocytoma Eclampsia |
| Nitrates | Isosorbide dinitrate 2-10mg/hr max 20mg/hr
Glyceryl trinitrate 10-20 mcg/min max 200 mcg/min |
Cardiac ischaemia
Cardiac failure/pulmonary oedema |
| Hydralazine | Initial 5-10mg slow bolus.
Then repeat boluses or infusion 50-100 mcg/min |
Eclampsia (second line treatment) |
| Nicardipine | Infusion of 2.5-5mg/hr.
Increase according to response by 0.5 – 1mg every 15 minutes to a maximum of 15mg/hr |
Eclampsia
Hypertensive encephalopathy |
| Phentolamine | 2-5mg bolus doses, repeated as necessary | Phaeochromocytoma |