Ketanserin in the acute management of severe hypertension

Ketanserin is a 5-HT2 antagonist with alpha-adrenoreceptor blocking activity. This study examines the efficacy and safety of ketanserin in the control of severe primary and secondary hypertension, including renal hypertension. Patients with uncontrolled hypertension were admitted to hospital and entered the study if the supine diastolic blood pressure phase V (SDBP) was greater than 110 mm Hg after 2 h continuous BP monitoring (Dynamap). Ketanserin was administered as an intravenous (i.v.) 5 mg bolus every 60 s until SDBP fell greater than 15 mm Hg or maximum dose (30 mg) was reached, then by i.v. infusion at 4-20 mg/h to maintain SDBP fall greater than 15 mm Hg over 6 h. Twenty five patients were monitored and 20 (seven men, 13 women, ages 14-65 years) fulfilled the entry criteria. Seventeen of 20 were on antihypertensive medication, and 14 had underlying renal disease. Preinjection mean BP was 188/123 mm Hg for the 20 patients, falling at 5 min to 175/103 mm Hg. Supine diastolic blood pressure fell greater than 15 mm Hg in 16 of 20 patients. In these patients, BP remained satisfactorily controlled over the 6-h ketanserin infusion. Heart rate was unchanged. The four patients who did not respond were receiving the alpha-blocker prazosin, but seven other patients on high-dose prazosin did respond. We conclude that i.v. ketanserin is effective in the acute management of severe hypertension, including hypertension secondary to renal disease.