Hypertensive Urgency or Emergency - Medications to consider

Nitroprusside an arteriolar and venous dilator, given as an intravenous infusion. Initial dose: 0.25 to 0.5 g/kg per min; maximum dose: 8 to 10 g/kg per min which should be continued for no more than 10 minutes.

Nitroglycerin a venous and, to a lesser degree, arteriolar dilator, given as an intravenous infusion. Initial dose: 5 g/min; maximum dose: 100 g/min.

Labetalol an alpha- and -adrenergic blocker, given as an intravenous bolus or infusion. Bolus: 20 mg initially, followed by 20 to 80 mg every 10 minutes to a total dose of 300 mg. Infusion: 0.5 to 2 mg/min.

Nicardipine a calcium channel blocker, given as an intravenous infusion. Initial dose: 5 mg/h; maximum dose: 15 mg/h.

Fenoldopam a peripheral dopamine-1 receptor agonist, given as an intravenous infusion. Initial dose: 0.1 g/kg per min; the dose is titrated at 15 min intervals, depending upon the blood pressure response.

Hydralazine an arteriolar dilator, given as an intravenous bolus. Initial dose: 10 mg given every 20 to 30 minutes; maximum dose: 20 mg.

Propranolol a -adrenergic blocker, given as an intravenous infusion and then followed by oral therapy. Dose: 1 to 10 mg load, followed by 3 mg/h.

Phentolamine an a-adrenergic blocker, given as an intravenous bolus. Dose: 5 to 10 mg every 5 to 15 minutes.

Enalaprilat
an angiotensin converting enzyme inhibitor, given as an intravenous bolus. Dose: 1.25 mg every six hours.