Current management of hypertensive emergencies

A number of potent and rapidly acting pharmacological agents are available to achieve safe, rapid, and controlled blood pressure reduction in most hypertensive crises. While sodium nitroprusside remains the drug of choice in many hypertensive emergencies, several newer agents are now available that may prove to be acceptable alternatives in the management of certain cases. Glyceryl trinitrate (nitroglycerin) and labetalol may be advantageous in patients with significant coronary artery disease. When adequate facilities to monitor continuous infusion of sodium nitroprusside are not immediately available, the intermittent minibolus administration of diazoxide or labetalol or the use of sublingual or oral nifedipine prove useful. A thorough knowledge of the pharmacological properties and proper indications of the currently used agents is essential for optimum management of the critically ill hypertensive patient.