[Antihypertensive management in acute cerebral stroke]

Hypertensive emergencies encompass a variety of clinical conditions and several drugs are now available for use in these situations. The clinician should take into account the specific etiology of the severe hypertension, co-existing conditions of patient, and the pharmacology of agents when selecting a drug for treatment. In the case of hypertensive encephalopathy, the lowering of blood pressure is therapeutic as well as diagnostic. If the mental status does not improve within a few hours of lowering the blood pressure, other causes of hypertension should be considered. Historically, nitroprusside has been the most commonly used agent in this clinical situation. Alternative drugs that are easy to administer include labetalol and fenoldopam. Nitroglycerin and nicardipine may also be effective but clinical experience in hypertensive encephalopathy is limited. Drugs that cause sedation such as clonidine should not be used in order to avoid confusion with the neurological assessment.