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Current and Newer Agents for Hypertensive Emergencies

Abstract

Hypertension is an increasingly prevalent chronic illness. The condition may present as a hypertensive crisis, and this entity may be further categorized as either hypertensive emergency or urgency. As the presentation is quite variable and is dependent upon the specific end-organ injury, a thorough history and examination are necessary. Once the underlying pathology is known, a target blood pressure can be determined and a specific therapeutic agent selected. The choice of most appropriate agent must take into consideration coexisting morbidities, desired rate of blood pressure decline, monitoring capabilities of the environment, and experience of the clinician. In hypertensive emergencies, the therapeutic goal is to protect remaining end-organ function, reduce the risk of complications, and thereby improve patient outcomes. This article reviews commonly used antihypertensive medications as well as evidence-based recommendations for state-of-the-art treatment for hypertensive emergencies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension. 2008;52(5):818–27.

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Vital signs: prevalence, treatment, and control of hypertension--United States, 1999-2002 and 2005-2008. Morb Mortal Wkly Rep. 2011;60(4):103-8.

  3. 3.

    Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290(2):199–206.

    PubMed  Article  Google Scholar 

  4. 4.

    Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25–e146.

    PubMed  Article  Google Scholar 

  5. 5.

    Whitworth JA. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21(11):1983–92.

    PubMed  Article  Google Scholar 

  6. 6.

    Volhard F. Die Brightsche Nierenkrankheit: Springer; 1914.

  7. 7.

    Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1974;268(6):336–45.

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Lenfant C, Chobanian AV, Jones DW, Roccella EJ. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails. Hypertension. 2003;41(6):1178–9.

    CAS  PubMed  Article  Google Scholar 

  9. 9.•

    James PA, Oparil S, Carter BL, et al. evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. This latest report of the JNC offers classes of medications that can be used for BP control. Although this review does not adress the hypertensive crisis, it is one of the most important references in the United States and throughout the world for treating this pathology.

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Varon J, Marik PE. The diagnosis and management of hypertensive crises. Chest. 2000;118(1):214–27.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Varon J. Treatment of acute severe hypertension: current and newer agents. Drugs. 2008;68(3):283–97.

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Varon J. Diagnosis and management of labile blood pressure during acute cerebrovascular accidents and other hypertensive crises. Am J Emerg Med. 2007;25(8):949–59.

    PubMed  Article  Google Scholar 

  13. 13.

    Schiller JS, Lucas JW, Ward BW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Vital and health statistics Series 10, Data from the National Health Survey. 2012(252):1-207

  14. 14.

    Prisant LM, Carr AA, Hawkins DW. Treating hypertensive emergencies. Controlled reduction of blood pressure and protection of target organs. Postgrad Med. 1993;93(2):92–6. 101-4, 8-10.

    CAS  PubMed  Google Scholar 

  15. 15.

    Marik PE, Varon J. Hypertensive crises: challenges and management. Chest. 2007;131(6):1949–62.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Varon J, Marik P. Clinical review: the management of hypertensive crises. Crit Care. 2003;7(5):374–84.

    PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    Ault MJ, Ellrodt AG. Pathophysiological events leading to the end-organ effects of acute hypertension. Am J Emerg Med. 1985;3(6 Suppl):10–5.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Wallach R, Karp RB, Reves JG, Oparil S, Smith LR, James TN. Pathogenesis of paroxysmal hypertension developing during and after coronary bypass surgery: a study of hemodynamic and humoral factors. Am J Cardiol. 1980;46(4):559–65.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Han Y, Runge MS, Brasier AR. Angiotensin II induces interleukin-6 transcription in vascular smooth muscle cells through pleiotropic activation of nuclear factor-kappa B transcription factors. Circ Res. 1999;84(6):695–703.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension. 1996;27(1):144–7.

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Garcia Jr JY, Vidt DG. Current management of hypertensive emergencies. Drugs. 1987;34(2):263–78.

    PubMed  Article  Google Scholar 

  22. 22.

    Finnerty Jr FA. Management of hypertensive encephalopathy. Herz. 1978;3(5):300–4.

    PubMed  Google Scholar 

  23. 23.

    Chen K, Varon J, Wenker OC, Judge DK, Fromm Jr RE, Sternbach GL. Acute thoracic aortic dissection: the basics. J Emerg Med. 1997;15(6):859–67.

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest. 2002;122(1):311–28.

    PubMed  Article  Google Scholar 

  25. 25.

    Estrera AL, Miller 3rd CC, Safi HJ, et al. Outcomes of medical management of acute type B aortic dissection. Circulation. 2006;114(1 Suppl):I384–9.

    PubMed  Google Scholar 

  26. 26.

    Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356(9227):411–7.

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001;344(1):17–22.

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Weder AB, Erickson S. Treatment of hypertension in the inpatient setting: use of intravenous labetalol and hydralazine. J Clin Hypertens. 2010;12(1):29–33.

    CAS  Article  Google Scholar 

  29. 29.••

    Fontes ML, Varon J. Perioperative hypertensive crisis: newer concepts. Int Anesthesiol Clin. 2012;50(2):40–58. Over 72 million of Americans have hypertension. Of the patients that present to non-cardiac surgery one third are hypertensive. The consequences of hypertension are been associated with multiple target-organ complications. This article provides an overview of hypertensive crises.

    PubMed  Article  Google Scholar 

  30. 30.

    Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk. 2008;4(3):615–27.

    CAS  Google Scholar 

  31. 31.•

    Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368(25):2355–65. This study randomly assigned patients with spontaneous intracerebral hemorrhage to receive therapy to lower systolic blood pressure to either <180mmHg (guideline-recommended) or <140mmHg. Subjects demostrated improved functional outcomes with intensive SBP lowering treatment.

    CAS  PubMed  Article  Google Scholar 

  32. 32.•

    Hill MD, Muir KW. INTERACT-2: should blood pressure be aggressively lowered acutely after intracerebral hemorrhage? Stroke. 2013;44(10):2951–2. This study randomly assigned patients with spontaneous intracerebral hemorrhage to receive therapy to lower systolic blood pressure to either <180mmHg (guideline-recommended) or <140mmHg. They demostrated that <140mmHg is a safe target and suggested that additional data is required to recommend this practice.

    PubMed  Article  Google Scholar 

  33. 33.•

    Sarafidis PA, Georgianos PI, Malindretos P, Liakopoulos V. Pharmacological management of hypertensive emergencies and urgencies: focus on newer agents. Expert Opin Investig Drugs. 2012;21(8):1089–106. In this review the author suggests the use of less toxic hypertensive agents like nicardipine, fenoldopam, labetalol and esmolol over older agents such as nitroprusside, nitroglycerin and hydralaizne.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Schirger A, Spittell Jr JA. Pharmacology and clinical use of hydralazine in the treatment of diastolic hypertension. Am J Cardiol. 1962;9:854–9.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Cogan JJ, Humphreys MH, Carlson CJ, Rapaport E. Renal effects of nitroprusside and hydralazine in patients with congestive heart failure. Circulation. 1980;61(2):316–23.

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Magee LA, Cham C, Waterman EJ, Ohlsson A, von Dadelszen P. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ. 2003;327(7421):955–60.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  37. 37.

    Tumlin JA, Dunbar LM, Oparil S, et al. Fenoldopam, a dopamine agonist, for hypertensive emergency: a multicenter randomized trial. Fenoldopam Study Group. Acad Emerg Med. 2000;7(6):653–62.

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Elliott WJ, Weber RR, Nelson KS, et al. Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension. Circulation. 1990;81(3):970–7.

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Reisin E, Huth MM, Nguyen BP, Weed SG, Gonzalez FM. Intravenous fenoldopam versus sodium nitroprusside in patients with severe hypertension. Hypertension. 1990;15(2 Suppl):I59–62.

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Duprez D. Arterial Hypertension. In: Toth PP, Cannon CP, editors. Comprehensive Cardiovascular Medicine in the Primary Care Setting: Humana Press; 2011. p. 25-58.

  41. 41.

    Friederich JA, Butterworth JF. Sodium nitroprusside: twenty years and counting. Anesth Analg. 1995;81(1):152–62.

    CAS  PubMed  Google Scholar 

  42. 42.

    Cohn JN, Franciosa JA, Francis GS, et al. Effect of short-term infusion of sodium nitroprusside on mortality rate in acute myocardial infarction complicated by left ventricular failure: results of a Veterans Administration cooperative study. N Engl J Med. 1982;306(19):1129–35.

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Mann T, Cohn PF, Holman LB, Green LH, Markis JE, Phillips DA. Effect of nitroprusside on regional myocardial blood flow in coronary artery disease. Results in 25 patients and comparison with nitroglycerin. Circulation. 1978;57(4):732–8.

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Griswold WR, Reznik V, Mendoza SA. Nitroprusside-induced intracranial hypertension. JAMA. 1981;246(23):2679–80.

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Hall VA, Guest JM. Sodium nitroprusside-induced cyanide intoxication and prevention with sodium thiosulfate prophylaxis. Am J Crit Care. 1992;1(2):19–25.

    CAS  PubMed  Google Scholar 

  46. 46.

    Parent R, Leblanc N, Lavallee M. Nitroglycerin reduces myocardial oxygen consumption during exercise despite vascular tolerance. Am J Physiol Heart Circ Physiol. 2006;290(3):H1226–34.

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Flaherty JT, Magee PA, Gardner TL, Potter A, MacAllister NP. Comparison of intravenous nitroglycerin and sodium nitroprusside for treatment of acute hypertension developing after coronary artery bypass surgery. Circulation. 1982;65(6):1072–7.

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Brundtland GH. From the World Health Organization. Reducing risks to health, promoting healthy life. JAMA. 2002;288(16):1974.

    PubMed  Article  Google Scholar 

  49. 49.

    Toman J, Lupinek Z, Janousek S, Nechvatal L, Zeman K. Hemodynamic effects of transdermal nitroglycerin patches in patients with acute myocardial infarction. Cardiology. 1991;79 Suppl 2:58–62.

    PubMed  Article  Google Scholar 

  50. 50.

    Levy JH. Treatment of perioperative hypertension. Anesthsiol Clin of N Am. 1999;17(3):567–79.

    Article  Google Scholar 

  51. 51.

    Munoz Alameda LE, Barcina Sanchez M. [Intravenous nicardipine: a new calcium antagonist for perioperative use. Rev Esp Anestesiol Reanim. 2001;48(2):71–80.

    CAS  PubMed  Google Scholar 

  52. 52.

    Wallin JD, Cook ME, Blanski L, et al. Intravenous nicardipine for the treatment of severe hypertension. Am J Med. 1988;85(3):331–8.

    CAS  PubMed  Article  Google Scholar 

  53. 53.

    Sorkin E, Clissold S. Nicardipine. Drugs. 1987;33(4):296–345.

    CAS  PubMed  Article  Google Scholar 

  54. 54.

    Kross RA, Ferri E, Leung D, et al. A comparative study between a calcium channel blocker (Nicardipine) and a combined alpha-beta-blocker (Labetalol) for the control of emergence hypertension during craniotomy for tumor surgery. Anesth Analg. 2000;91(4):904–9.

    CAS  PubMed  Article  Google Scholar 

  55. 55.

    Drozda Jr J, Messer JV, Spertus J, et al. ACCF/AHA/AMA-PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association-Physician Consortium for Performance Improvement. J Am Coll Cardiol. 2011;58(3):316–36.

    PubMed  Article  Google Scholar 

  56. 56.

    Neutel JM, Smith DH, Wallin D, et al. A comparison of intravenous nicardipine and sodium nitroprusside in the immediate treatment of severe hypertension. Am J Hypertens. 1994;7(7 Pt 1):623–8.

    CAS  PubMed  Google Scholar 

  57. 57.••

    Peacock WF, Varon J, Baumann BM, et al. CLUE: a randomized comparative effectiveness trial of IV nicardipine versus labetalol use in the emergency department. Crit Care. 2011;15(3):R157. This was a multicenter randomized clnical trial with the objective of comparing IV nicardipine versus IV labetalol using doses recommended by the food and drug administration. A total of 226 patients were enrolled. Nicardipine-receiving patient reached BP goals more often than labetalol-receiving patients 30 minutes after the dose. No significant diference in adverse effects was noted.

    PubMed Central  PubMed  Article  Google Scholar 

  58. 58.

    Rivera A, Montoya E, Varon J. Intravenous clevidipine for management of hypertension. Integr Blood Press Control. 2010;3:105–11.

    CAS  PubMed Central  PubMed  Google Scholar 

  59. 59.••

    Espina IM, Varon J. Clevidipine : a state-of-the-art antihypertensive drug under the scope. Expert Opin Pharmacother. 2012;13(3):387–93. This article analyzed the characteristics of Clevidipine including half-life, interaction, dosings and efficacy. Over 90% of patients receiving clevidipine reached target blood pressure within 30 minutes of administration.

    CAS  PubMed  Article  Google Scholar 

  60. 60.

    Levy JH, Mancao MY, Gitter R, et al. Clevidipine effectively and rapidly controls blood pressure preoperatively in cardiac surgery patients: the results of the randomized, placebo-controlled efficacy study of clevidipine assessing its preoperative antihypertensive effect in cardiac surgery-1. Anesth Analg. 2007;105(4):918–25.

    CAS  PubMed  Article  Google Scholar 

  61. 61.•

    Tulman DB, Stawicki SP, Papadimos TJ, Murphy CV, Bergese SD. Advances in management of acute hypertension: a concise review. Disc Med. 2012;13(72):375–83. This review focuses on Clevdipine as an effective hypotensive agents, focusing on the pharmacodynamic and pharmacokinect properties and the saftly profile.

    Google Scholar 

  62. 62.•

    Mirtallo JM, Dasta JF, Kleinschmidt KC, Varon J. State of the art review: Intravenous fat emulsions: current applications, safety profile, and clinical implications. Ann Pharmacother. 2010;44(4):688–700. This review focuses on propofol and clevidipine to assess the safety profile of intravenous fat emulsions, demonstrating a low rate of lipid-related adverse effects when administrered within guideline recommendations.

    CAS  PubMed  Google Scholar 

  63. 63.

    Singla N, Warltier DC, Gandhi SD, et al. Treatment of acute postoperative hypertension in cardiac surgery patients: an efficacy study of clevidipine assessing its postoperative antihypertensive effect in cardiac surgery-2 (ESCAPE-2), a randomized, double-blind, placebo-controlled trial. Anesth Analg. 2008;107(1):59–67.

    CAS  PubMed  Article  Google Scholar 

  64. 64.•

    Aronson S, Dyke CM, Stierer KA, et al. The ECLIPSE trials: comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients. Anesth Analg. 2008;107(4):1110–21. Data from three prospective studies demostrate that there was no difference in the incidence of adverse effects between clevidipine-receiving patients compared with the other hypotensive drugs.

    CAS  PubMed  Article  Google Scholar 

  65. 65.•

    Peacock F, Varon J, Ebrahimi R, Dunbar L, Pollack Jr CV. Clevidipine for severe hypertension in acute heart failure: a VELOCITY trial analysis. Congest Heart Fail. 2010;16(2):55–9. In patients with acute heart failure, there were no treatment-related adverse effects, demostrating that clevidipine is a safe agent to decrease SBP in this group of patients.

    CAS  PubMed  Article  Google Scholar 

  66. 66.

    Conner CS. Labetalol: an alpha- and beta-blocker. Drug Intell Clin Pharm. 1983;17(7–8):543–4.

    CAS  PubMed  Google Scholar 

  67. 67.

    Huey J, Thomas JP, Hendricks DR, Wehmeyer AE, Johns LJ, MacCosbe PE. Clinical evaluation of intravenous labetalol for the treatment of hypertensive urgency. Am J Hypertens. 1988;1(3 Pt 3):284s–9s.

    CAS  PubMed  Article  Google Scholar 

  68. 68.

    Wright JT, Wilson DJ, Goodman RP, Minisi AJ. Labetalol by continuous intravenous infusion in severe hypertension. J Clin Hypertens. 1986;2(1):39–43.

    PubMed  Google Scholar 

  69. 69.

    Richards DA. Pharmacological effects of labetalol in man. Brit J Clin Pharmacol. 1976;3(4 Suppl 3):721–3.

    CAS  Google Scholar 

  70. 70.••

    Cannon CM, Levy P, Baumann BM, et al. Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial. BMJ open. 2013;3(3). The objective of this study was to compare IV infusion of nicardipine vs IV bolus of labetalol to manage hypertensive emergencies. Of the 141 patients who were enrolled, 49.6% received nicardipine and 51.7% received labetalol. Patients receiving nicardipine were statisticaly more likely to reach target SBP within 30 minutes than those who received labetalol.

  71. 71.

    MacCarthy EP, Bloomfield SS. Labetalol: a review of its pharmacology, pharmacokinetics, clinical uses and adverse effects. Pharmacotherapy. 1983;3(4):193–219.

    CAS  PubMed  Google Scholar 

  72. 72.•

    Shekhar S, Sharma C, Thakur S, Verma S. Oral nifedipine or intravenous labetalol for hypertensive emergency in pregnancy: a randomized controlled trial. Obstet Gynecol. 2013;122(5):1057–63. This trial pregant women with SBP >159mmHg or DPB >109mmHg received 10mg of nifedipine PO, 20,40,80mg of labetalol or IV or placebo. Nifedipinelowered blood pressure more quickly than labetalol.

    CAS  PubMed  Article  Google Scholar 

  73. 73.

    Papadopoulos DP, Mourouzis I, Thomopoulos C, Makris T, Papademetriou V. Hypertension crisis. Blood Press. 2010;19(6):328–36.

    PubMed  Article  Google Scholar 

  74. 74.••

    Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50(7):e1–e157. This ACC/AHA Guidelines defined systolic hypertension as a predictor of adverse outcome in UA/NSTEMI, and recommend medical management and lifestyle changes.

    PubMed  Article  Google Scholar 

  75. 75.

    Gray RJ. An ultra short-acting beta-adrenergic blocker. Chest. 1988;93(2):398–403.

    CAS  PubMed  Article  Google Scholar 

  76. 76.

    Rosei EA, Trust PM, Brown JJ, Lever AF, Robertson JI. Letter: intravenous labetalol in severe hypertension. Lancet. 1975;2(7944):1093–4.

    CAS  PubMed  Article  Google Scholar 

  77. 77.

    Turlapaty P, Laddu A, Murthy VS, Singh B, Lee R. Esmolol: a titratable short-acting intravenous beta blocker for acute critical care settings. Am Heart J. 1987;114(4 Pt 1):866–85.

    CAS  PubMed  Article  Google Scholar 

  78. 78.

    Esmolol WD. A review of its therapeutic efficacy and pharmacokinetic characteristics. Clin Pharmacokinet. 1995;28(3):190–202.

    Article  Google Scholar 

  79. 79.

    Varon J. The diagnosis and treatment of hypertensive crises. Postgrad Med. 2009;121(1):5–13.

    PubMed  Article  Google Scholar 

  80. 80.

    Zangrillo A, Turi S, Crescenzi G, et al. Esmolol reduces perioperative ischemia in cardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth. 2009;23(5):625–32.

    CAS  PubMed  Article  Google Scholar 

  81. 81.

    Ziegler MG. Advances in the acute therapy of hypertension. Crit Care Med. 1992;20(12):1630–1.

    CAS  PubMed  Article  Google Scholar 

  82. 82.

    McMillian WD, Trombley BJ, Charash WE, Christian RC. Phentolamine continuous infusion in a patient with pheochromocytoma. Am J Health Syst Pharm. 2011;68(2):130–4.

    CAS  PubMed  Article  Google Scholar 

  83. 83.

    Rhoney D, Peacock WF. Intravenous therapy for hypertensive emergencies, part 2. Am J Health Syst Pharm. 2009;66(16):1448–57.

    CAS  PubMed  Article  Google Scholar 

  84. 84.

    Curry SC, Arnold-Capell P. Toxic effects of drugs used in the ICU. Nitroprusside, nitroglycerin, and angiotensin-converting enzyme inhibitors. Crit Care Clin. 1991;7(3):555–81.

    CAS  PubMed  Google Scholar 

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Conflict of Interest

Alan Padilla Ramos declares that he has no conflict of interest.

Joseph Varon is a consultant and part of the speaker’s bureau for the Medicines Company, Baxter Pharmaceutical and Cornerstone Pharmaceutical.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Joseph Varon.

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This article is part of the Topical Collection on Hypertensive Emergencies

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Padilla Ramos, A., Varon, J. Current and Newer Agents for Hypertensive Emergencies. Curr Hypertens Rep 16, 450 (2014). https://doi.org/10.1007/s11906-014-0450-z

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Keywords

  • Hypertension
  • Hypertensive crisis
  • Hypertensive emergency
  • Hypertensive urgency
  • Blood pressure control
  • Nicardipine
  • Clevidipine
  • Labetalol
  • Clinical trials