, Volume 68, Issue 3, pp 283–297 | Cite as

Treatment of Acute Severe Hypertension

Current and Newer Agents
Review Article


Approximately 72 million people in the US experience hypertension. Worldwide, hypertension may affect as many as 1 billion people and be responsible for ≈7.1 million deaths per year. It is estimated that ≈1% of patients with hypertension will, at some point, develop a hypertensive crisis. Hypertensive crises are further defined as either hypertensive emergencies or urgencies, depending on the degree of blood pressure elevation and presence of end-organ damage. Immediate reduction in blood pressure is required only in patients with acute end-organ damage (i.e. hypertensive emergency) and requires treatment with a titratable, short-acting, intravenous antihypertensive agent, while severe hypertension without acute end-organ damage (i.e. hypertensive urgency) is usually treated with oral antihypertensive agents.

The primary goal of intervention in a hypertensive crisis is to safely reduce blood pressure. The appropriate therapeutic approach of each patient will depend on their clinical presentation. Patients with hypertensive emergencies are best treated in an intensive care unit with titratable, intravenous, hypotensive agents. Rapid-acting intravenous antihypertensive agents are available, including labetalol, esmolol, fenoldopam, nicardipine and sodium nitroprusside. Newer agents, such as clevidipine and fenoldopam, may hold considerable advantages to other available agents in the management of hypertensive crises. Sodium nitroprusside is an extremely toxic drug and its use in the treatment of hypertensive emergencies should be avoided. Similarly, nifedipine, nitroglycerin and hydralazine should not to be considered first-line therapies in the management of hypertensive crises because these agents are associated with significant toxicities and/or adverse effects.


  1. 1.
    Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics: 2007 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007 Feb 6; 115(5): e69–171PubMedGoogle Scholar
  2. 2.
    National Center for Health Statistics (U.S.). Health, United States, 2005 with chartbook on trends in the health of Americans with special feature on drugs. Hyattsville (MD), Washington, DC: Department of Health and Human Services, Centers for Disease Control and Prevention, 2005Google Scholar
  3. 3.
    Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003 Jul 9; 290(2): 199–206PubMedGoogle Scholar
  4. 4.
    Kearse Jr LA, Rosow C, Zaslavsky A, et al. Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis. Anesthesiology 1998 Jan; 88(1): 25–34PubMedGoogle Scholar
  5. 5.
    Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995 Mar; 25(3): 305–13PubMedGoogle Scholar
  6. 6.
    Burt VL, Cutler JA, Higgins M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population: data from the health examination surveys, 1960 to 1991. Hypertension 1995 Jul; 26(1): 60–9PubMedGoogle Scholar
  7. 7.
    Dannenberg AL, Garrison RJ, Kannel WB. Incidence of hypertension in the Framingham Study. Am J Public Health 1988 Jun; 78(6): 676–9PubMedGoogle Scholar
  8. 8.
    WHO. Reducing risks, promoting healthy life: the world health report. Geneva: World Health Organization, 2002Google Scholar
  9. 9.
    Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: a cooperative study. JAMA 1977 Jan 17; 237(3): 255–61Google Scholar
  10. 10.
    The 1980 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1980 Oct; 140(10): 1280–5Google Scholar
  11. 11.
    The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1984 May; 144(5): 1045–57Google Scholar
  12. 12.
    The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1988 May; 148(5): 1023–38Google Scholar
  13. 13.
    The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1993 Jan 25; 153(2): 154–83Google Scholar
  14. 14.
    The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997 Nov 24; 157(21): 2413–46Google Scholar
  15. 15.
    Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003 May 21; 289(19): 2560–72PubMedGoogle Scholar
  16. 16.
    Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003 Dec; 42(6): 1206–52PubMedGoogle Scholar
  17. 17.
    Joint National Committee on Detection Evaluation and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, JNC7 (complete report). NIH Publication No. 04-5230. Bethesda (MD): National Heart, Lung, and Blood Institute, Health Information Center, 2004Google Scholar
  18. 18.
    Lip GY, Beevers M, Potter JF, et al. Malignant hypertension in the elderly. QJM 1995 Sep; 88(9): 641–7PubMedGoogle Scholar
  19. 19.
    Smith CB, Flower LW, Reinhardt CE. Control of hypertensive emergencies. Postgrad Med 1991 Apr; 89(5): 111–6, 9PubMedGoogle Scholar
  20. 20.
    Kaplan NM. Treatment of hypertensive emergencies and urgencies. Heart Dis Stroke 1992 Nov–Dec; 1(6): 373–8PubMedGoogle Scholar
  21. 21.
    Bennett NM, Shea S. Hypertensive emergency: case criteria, sociodemographic profile, and previous care of 100 cases. Am J Public Health 1988 Jun; 78(6): 636–40PubMedGoogle Scholar
  22. 22.
    McRae Jr RP, Liebson PR. Hypertensive crisis. Med Clin North Am 1986 Jul; 70(4): 749–67PubMedGoogle Scholar
  23. 23.
    Vidt DG. Current concepts in treatment of hypertensive emergencies. Am Heart J 1986 Jan; 111(1): 220–5PubMedGoogle Scholar
  24. 24.
    Gifford Jr RW. Management of hypertensive crises. JAMA 1991 Aug 14; 266(6): 829–35PubMedGoogle Scholar
  25. 25.
    Calhoun DA, Oparil S. Treatment of hypertensive crisis. N Engl J Med 1990 Oct 25; 323(17): 1177–83PubMedGoogle Scholar
  26. 26.
    Rahn KH. How should we treat a hypertensive emergency? Am J Cardiol 1989 Feb 2; 63(6): 48–50CGoogle Scholar
  27. 27.
    Reuler JB, Magarian GJ. Hypertensive emergencies and urgencies: definition, recognition, and management. J Gen Intern Med 1988 Jan–Feb; 3(1): 64–74PubMedGoogle Scholar
  28. 28.
    Ferguson RK, Vlasses PH. Hypertensive emergencies and urgencies. JAMA 1986 Mar 28; 255(12): 1607–13PubMedGoogle Scholar
  29. 29.
    Varon J, Marik PE. Clinical review: the management of hypertensive crises. Crit Care 2003 Oct; 7(5): 374–84PubMedGoogle Scholar
  30. 30.
    Bertel O, Marx BE, Conen D. Effects of antihypertensive treatment on cerebral perfusion. Am J Med 1987 Mar 30; 82(3B): 29–36PubMedGoogle Scholar
  31. 31.
    Bannan LT, Beevers DG, Wright N. ABC of blood pressure reduction: emergency reduction, hypertension in pregnancy, and hypertension in the elderly. BMJ 1980 Oct 25; 281(6248): 1120–2PubMedGoogle Scholar
  32. 32.
    Strandgaard S, Olesen J, Skinhoj E, et al. Autoregulation of brain circulation in severe arterial hypertension. BMJ 1973 Mar 3; 1(5852): 507–10PubMedGoogle Scholar
  33. 33.
    Varon J, Marik PE. The diagnosis and management of hypertensive crises. Chest 2000 Jul; 118(1): 214–27PubMedGoogle Scholar
  34. 34.
    Greene CS, Gretler DD, Cervenka K, et al. Cerebral blood flow during the acute therapy of severe hypertension with oral clonidine. Am J Emerg Med 1990 Jul; 8(4): 293–6PubMedGoogle Scholar
  35. 35.
    Houston MC. The comparative effects of clonidine hydrochloride and nifedipine in the treatment of hypertensive crises. Am Heart J 1988 Jan; 115 (1 Pt 1): 152–9PubMedGoogle Scholar
  36. 36.
    Marik PE, Varon J. Hypertensive crises: challenges and management. Chest 2007 Jun; 131(6): 1949–62PubMedGoogle Scholar
  37. 37.
    Rey E, LeLorier J, Burgess E, et al. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ 1997 Nov 1; 157(9): 1245–54PubMedGoogle Scholar
  38. 38.
    Alper A, Calhoun D. Hypertensive emergencies. In: Antman EM, editor. Cardiovascular therapeutics: a companion to Braunwald’s Heart disease. 2nd ed. Philadelphia (PA): W.B. Saunders Co., 2002: 817–31Google Scholar
  39. 39.
    Plets C. Arterial hypertension in neurosurgical emergencies. Am J Cardiol 1989 Feb 2; 63(6): 40–2CGoogle Scholar
  40. 40.
    Halpern NA, Alicea M, Krakoff LR, et al. Postoperative hypertension: a prospective, placebo-controlled, randomized, double-blind trial, with intravenous nicardipine hydrochloride. Angiology 1990 Nov; 41 (11 Pt 2): 992–1004PubMedGoogle Scholar
  41. 41.
    Prys-Rroberts C. Anaesthesia and hypertension. Br J Anaesth 1984 Jul; 56(7): 711–24PubMedGoogle Scholar
  42. 42.
    Gal TJ, Cooperman LH. Hypertension in the immediate postoperative period. Br J Anaesth 1975 Jan; 47(1): 70–4PubMedGoogle Scholar
  43. 43.
    Lisk DR, Grotta JC, Lamki LM, et al. Should hypertension be treated after acute stroke? A randomized controlled trial using ingle photon emission computed tomography. Arch Neurol 1993 Aug; 50(8): 855–62PubMedGoogle Scholar
  44. 44.
    Brott T, Lu M, Kothari R, et al. Hypertension and its treatment in the NINDS rt-PA Stroke Trial. Stroke 1998 Aug; 29(8): 1504–9PubMedGoogle Scholar
  45. 45.
    Leonardi-Bee J, Bath PM, Phillips SJ, et al. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke 2002 May; 33(5): 1315–20PubMedGoogle Scholar
  46. 46.
    Oliveira-Filho J, Silva SC, Trabuco CC, et al. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset. Neurology 2003 Oct 28; 61(8): 1047–51PubMedGoogle Scholar
  47. 47.
    Varon J. Diagnosis and management of labile blood pressure during acute cerebrovascular accidents and other hypertensive crises. Ann Emerg Med 2007; 25: 949–59Google Scholar
  48. 48.
    Ault MJ, Ellrodt AG. Pathophysiological events leading to the end-organ effects of acute hypertension. Am J Emerg Med 1985 Dec; 3 (6 Suppl.): 10–5PubMedGoogle Scholar
  49. 49.
    Wallach R, Karp RB, Reves JG, et al. Pathogenesis of paroxysmal hypertension developing during and after coronary bypass surgery: a study of hemodynamic and humoral factors. Am J Cardiol 1980 Oct; 46(4): 559–65PubMedGoogle Scholar
  50. 50.
    Reed WG, Anderson RJ. Effects of rapid blood pressure reduction on cerebral blood flow. Am Heart J 1986 Jan; 111(1): 226–8PubMedGoogle Scholar
  51. 51.
    Chen K, Varon J, Wenker OC, et al. Acute thoracic aortic dissection: the basics. J Emerg Med 1997 Nov–Dec; 15(6): 859–67PubMedGoogle Scholar
  52. 52.
    Garcia Jr JY, Vidt DG. Current management of hypertensive emergencies. Drugs 1987 Aug; 34(2): 263–78PubMedGoogle Scholar
  53. 53.
    Grossman E, Messerli FH, Grodzicki T, et al. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA 1996 Oct; 276(16): 1328–31PubMedGoogle Scholar
  54. 54.
    Levy JH. Treatment of perioperative hypertension. Anesthesiol Clin North Am 1999; 17(3): 567–80Google Scholar
  55. 55.
    Estrera AL, Miller 3rd CC, Safi HJ, et al. Outcomes of medical management of acute type B aortic dissection. Circulation 2006 Jul 4; 114 (1 Suppl.): 1384–9Google Scholar
  56. 56.
    Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest 2002 Jul; 122(1): 311–28PubMedGoogle Scholar
  57. 57.
    Khot UN, Novaro GM, Popovic ZB, et al. Nitroprusside in critically ill patients with left ventricular dysfunction and aortic stenosis. N Engl J Med 2003 May 1; 348(18): 1756–63PubMedGoogle Scholar
  58. 58.
    DiPette DJ, Ferraro JC, Evans RR, et al. Enalaprilat, an intravenous angiotensin-converting enzyme inhibitor, in hypertensive crises. Clin Pharmacol Ther 1985 Aug; 38(2): 199–204PubMedGoogle Scholar
  59. 59.
    Hirschl MM, Binder M, Bur A, et al. Impact of the reninangiotensin-aldosterone system on blood pressure response to intravenous enalaprilat in patients with hypertensive crises. J Hum Hypertens 1997 Mar; 11(3): 177–83PubMedGoogle Scholar
  60. 60.
    Nordlander M, Bjorkman JA, Regard HCG, et al. Pharmacokinetics and hemodynamic effects of an ultrashort-acting calcium antagonist [abstract]. Br J Anaesth 1996; 76 Suppl.: A24Google Scholar
  61. 61.
    Rodriguez G, Varon J. Clevidipine. A unique agent for the critical care practitioner. Crit Care Shock 2006 May; 9(2): 37–41Google Scholar
  62. 62.
    Merck & Co. I. Vasotec® I.V.(enalaprilat) prescribing information [online]. Available from URL: http://www.fda.gov/cder/foi/label/2001/19309s23lbl.pdf. [Accessed 2007 Jul 16]
  63. 63.
    Lund-Johansen P. Pharmacology of combined alpha-beta-blockade: II. Haemodynamic effects of labetalol. Drugs 1984; 28 Suppl. 2: 35–50PubMedGoogle Scholar
  64. 64.
    Kanto J, Allonen H, Kleimola T, et al. Pharmacokinetics of labetalol in healthy volunteers. Int J Clin Pharmacol Ther Toxicol 1981 Jan; 19(1): 41–4PubMedGoogle Scholar
  65. 65.
    Goldberg ME, Clark S, Joseph J, et al. Nicardipine versus placebo for the treatment of postoperative hypertension. Am Heart J 1990 Feb; 119 (2 Pt 2): 446–50PubMedGoogle Scholar
  66. 66.
    Bedford Laboratories. Labetolol HCL injection USP prescribing information [online]. Available from URL: http://www.bedfordlabs.com/products/inserts/LBTL-P02.pdf [Accessed 2007 Jul 16]
  67. 67.
    Pearce CJ, Wallin JD. Labetalol and other agents that block both alpha- and beta-adrenergic receptors. Cleve Clin J Med 1994 Jan–Feb; 61(1): 59–69; quiz 80-2PubMedGoogle Scholar
  68. 68.
    Marx PG, Reid DS. Labetalol infusion in acute myocardial infarction with systemic hypertension. Br J Clin Pharmacol 1979; 8 Suppl. 2: 233–8SGoogle Scholar
  69. 69.
    Olsen KS, Svendsen LB, Larsen FS, et al. Effect of labetalol on cerebral blood flow, oxygen metabolism and autoregulation in healthy humans. Br J Anaesth 1995 Jul; 75(1): 51–4PubMedGoogle Scholar
  70. 70.
    Wallin JD. Adrenoreceptors and renal function. J Clin Hypertens 1985 Jun; 1(2): 171–8PubMedGoogle Scholar
  71. 71.
    Rosei EA, Trust PM, Brown JJ, et al. Intravenous labetalol in severe hypertension [letter]. Lancet 1975 Nov 29; II(7944): 1093–4Google Scholar
  72. 72.
    Gray RJ. Managing critically ill patients with esmolol: an ultra short-acting beta-adrenergic blocker. Chest 1988 Feb; 93(2): 398–403PubMedGoogle Scholar
  73. 73.
    Lowenthal DT, Porter RS, Saris SD, et al. Clinical pharmacology, pharmacodynamics and interactions with esmolol. Am J Cardiol 1985 Oct 23; 56(11): 14–8FGoogle Scholar
  74. 74.
    Reynolds RD, Gorczynski RJ, Quon CY. Pharmacology and pharmacokinetics of esmolol. J Clin Pharmacol 1986 Mar; 26 Suppl. A: A3–14PubMedGoogle Scholar
  75. 75.
    Bedford Laboratories. Esmolol HCL injection prescribing information [online]. Available from URL: http://www.bedfordlabs.com/products/inserts/esmolol_pi.pdf [Accessed 2007 Jul 16]
  76. 76.
    Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). Developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005 Sep 20; 112(12): e154–235PubMedGoogle Scholar
  77. 77.
    Balser JR, Martinez EA, Winters BD, et al. Beta-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias. Anesthesiology 1998 Nov; 89(5): 1052–9PubMedGoogle Scholar
  78. 78.
    Platia EV, Michelson EL, Porterfield JK, et al. Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol 1989 Apr 15; 63(13): 925–9PubMedGoogle Scholar
  79. 79.
    Stumpf JL. Drug therapy of hypertensive crises. Clin Pharm 1988 Aug; 7(8): 582–91PubMedGoogle Scholar
  80. 80.
    Smerling A, Gersony WM. Esmolol for severe hypertension following repair of aortic coarctation. Crit Care Med 1990 Nov; 18(11): 1288–90PubMedGoogle Scholar
  81. 81.
    Gray RJ, Bateman TM, Czer LS, et al. Use of esmolol in hypertension after cardiac surgery. Am J Cardiol 1985 Oct 23; 56(11): 49–56FGoogle Scholar
  82. 82.
    Gray RJ, Bateman TM, Czer LS, et al. Comparison of esmolol and nitroprusside for acute post-cardiac surgical hypertension. Am J Cardiol 1987 Apr 1; 59(8): 887–91PubMedGoogle Scholar
  83. 83.
    Muzzi DA, Black S, Losasso TJ, et al. Labetalol and esmolol in the control of hypertension after intracranial surgery. Anesth Analg 1990 Jan; 70(1): 68–71PubMedGoogle Scholar
  84. 84.
    Bailey JM, Lu W, Levy JH, et al. Clevidipine in adult cardiac surgical patients: a dose-finding study. Anesthesiology 2002 May; 96(5): 1086–94PubMedGoogle Scholar
  85. 85.
    Ericsson H, Fakt C, Jolin-Mellgard A, et al. Clinical and pharmacokinetic results with a new ultrashort-acting calcium antagonist, clevidipine, following gradually increasing intravenous doses to healthy volunteers. Br J Clin Pharmacol 1999 May; 47(5): 531–8PubMedGoogle Scholar
  86. 86.
    Ericsson H, Tholander B, Regardh CG. In vitro hydrolysis rate and protein binding of clevidipine, a new ultrashort-acting calcium antagonist metabolised by esterases, in different animal species and man. Eur J Pharm Sci 1999 Apr; 8(1): 29–37PubMedGoogle Scholar
  87. 87.
    Segawa D, Sjoquist PO, Wang QD, et al. Calcium antagonist protects the myocardium from reperfusion injury by interfering with mechanisms directly related to reperfusion: an experimental study with the ultrashort-acting calcium antagonist clevidipine. J Cardiovasc Pharmacol 2000 Sep; 36(3): 338–43PubMedGoogle Scholar
  88. 88.
    Segawa D, Sjoquist PO, Wang QD, et al. Time-dependent cardioprotection with calcium antagonism and experimental studies with clevidipine in ischemic-reperfused pig hearts: part II. J Cardiovasc Pharmacol 2002 Sep; 40(3): 339–45PubMedGoogle Scholar
  89. 89.
    Stephens CT, Jandhyala BS. Effects of fenoldopam, a dopamine D-1 agonist, and clevidipine, a calcium channel antagonist, in acute renal failure in anesthetized rats. Clin Exp Hypertens 2002 May; 24(4): 301–13PubMedGoogle Scholar
  90. 90.
    Kieler-Jensen N, Jolin-Mellgard A, Nordlander M, et al. Coronary and systemic hemodynamic effects of clevidipine, an ultra-short-acting calcium antagonist, for treatment of hypertension after coronary artery surgery. Acta Anaesthesiol Scand 2000 Feb; 44(2): 186–93PubMedGoogle Scholar
  91. 91.
    Powroznyk AV, Vuylsteke A, Naughton C, et al. Comparison of clevidipine with sodium nitroprusside in the control of blood pressure after coronary artery surgery. Eur J Anaesthesiol 2003 Sep; 20(9): 697–703PubMedGoogle Scholar
  92. 92.
    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. In pressGoogle Scholar
  93. 93.
    Varon J, Peacock W, Garrison N, et al. Prolonged infusion of clevidipine results in safe and predictable blood pressure control in patients with acute severe hypertension. Chest 2007; 132(4): 477SGoogle Scholar
  94. 94.
    Higuchi S, Shiobara Y. Comparative pharmacokinetics of nicardipine hydrochloride, a new vasodilator, in various species. Xenobiotica 1980 Jun; 10(6): 447–54PubMedGoogle Scholar
  95. 95.
    PDL BioPharma I. Cardene® (nicardipine HCI) prescribing information [online]. Available from URL: http://www.cardeneiv.info/Cardene_Full_PI.pdf [Accessed 2007 Jul 16]
  96. 96.
    Schillinger D. Nifedipine in hypertensive emergencies: a prospective study. J Emerg Med 1987 Nov–Dec; 5(6): 463–73PubMedGoogle Scholar
  97. 97.
    Lambert CR, Hill JA, Feldman RL, et al. Effects of nicardipine on left ventricular function and energetics in man. Int J Cardiol 1986 Mar; 10(3): 237–50PubMedGoogle Scholar
  98. 98.
    Lambert CR, Hill JA, Feldman RL, et al. Effects of nicardipine on exercise- and pacing-induced myocardial ischemia in angina pectoris. Am J Cardiol 1987 Sep 1; 60(7): 471–6PubMedGoogle Scholar
  99. 99.
    Lambert CR, Hill JA, Nichols WW, et al. Coronary and systemic hemodynamic effects of nicardipine. Am J Cardiol 1985 Mar 1; 55(6): 652–6PubMedGoogle Scholar
  100. 100.
    Vincent JL, Berlot G, Preiser JC, et al. Intravenous nicardipine in the treatment of postoperative arterial hypertension. J Cardiothorac Vasc Anesth 1997 Apr; 11(2): 160–4PubMedGoogle Scholar
  101. 101.
    Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update. A guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 2007 Jun; 38(6): 2001–23PubMedGoogle Scholar
  102. 102.
    Adams H, Adams R, Del Zoppo G, et al. Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update. A scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke 2005 Apr; 36(4): 916–23PubMedGoogle Scholar
  103. 103.
    Adams Jr HP, Adams RJ, Brott T, et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke 2003 Apr; 34(4): 1056–83PubMedGoogle Scholar
  104. 104.
    van Harten J, Burggraaf K, Danhof M, et al. Negligible sublingual absorption of nifedipine. Lancet 1987 Dec 12; II(8572): 1363–5Google Scholar
  105. 105.
    Pfizer Labs. Procardia® (nifedipine) prescribing information [online]. Available from URL: http://www.pfizer.com/pfizer/download/uspi_procardia.pdf [Accessed 2007 Jul 16]
  106. 106.
    Huysmans FT, Sluiter HE, Thien TA, et al. Acute treatment of hypertensive crisis with nifedipine. Br J Clin Pharmacol 1983 Dec; 16(6): 725–7PubMedGoogle Scholar
  107. 107.
    Bodmann KF, Troster S, Clemens R, et al. Hemodynamic profile of intravenous fenoldopam in patients with hypertensive crisis. Clin Investig 1993 Dec; 72(1): 60–4PubMedGoogle Scholar
  108. 108.
    Munger MA, Rutherford WF, Anderson L, et al. Assessment of intravenous fenoldopam mesylate in the management of severe systemic hypertension. Crit Care Med 1990 May; 18(5): 502–4PubMedGoogle Scholar
  109. 109.
    White WB, Radford MJ, Gonzalez FM, et al. Selective dopamine-1 agonist therapy in severe hypertension: effects of intravenous fenoldopam. J Am Coll Cardiol 1988 May; 11(5): 1118–23PubMedGoogle Scholar
  110. 110.
    Weber RR, McCoy CE, Ziemniak JA, et al. Pharmacokinetic and pharmacodynamic properties of intravenous fenoldopam, a dopamine1-receptor agonist, in hypertensive patients. Br J Clin Pharmacol 1988 Jan; 25(1): 17–21PubMedGoogle Scholar
  111. 111.
    Bedford Laboratories. Fenoldopam mesylate injection USP prescribing information [online]. Available from URL: http://www.bedfordlabs.com/products/inserts/fenoldopam_pi.pdf [Accessed 2007 Jul 16]
  112. 112.
    Shusterman NH, Elliott WJ, White WB. Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am J Med 1993 Aug; 95(2): 161–8PubMedGoogle Scholar
  113. 113.
    Elliott WJ, Weber RR, Nelson KS, et al. Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension. Circulation 1990 Mar; 81(3): 970–7PubMedGoogle Scholar
  114. 114.
    White WB, Halley SE. Comparative renal effects of intravenous administration of fenoldopam mesylate and sodium nitroprusside in patients with severe hypertension. Arch Intern Med 1989 Apr; 149(4): 870–4PubMedGoogle Scholar
  115. 115.
    Ng TM, Shurmur SW, Silver M, et al. Comparison of N-acetylcysteine and fenoldopam for preventing contrast-induced nephropathy (CAFCIN). Int J Cardiol 2006 May 24; 109(3): 322–8PubMedGoogle Scholar
  116. 116.
    Pannu N, Wiebe N, Tonelli M. Prophylaxis strategies for contrast-induced nephropathy. JAMA 2006 Jun 21; 295(23): 2765–79PubMedGoogle Scholar
  117. 117.
    Tumlin JA, Finkel KW, Murray PT, et al. Fenoldopam mesylate in early acute tubular necrosis: a randomized, double-blind, placebo-controlled clinical trial. Am J Kidney Dis 2005 Jul; 46(1): 26–34PubMedGoogle Scholar
  118. 118.
    Landoni G, Biondi-Zoccai GG, Tumlin JA, et al. Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials. Am J Kidney Dis 2007 Jan; 49(1): 56–68PubMedGoogle Scholar
  119. 119.
    Schroeder HA. Effects on hypertension of sulfhydryl and hydrazine compounds. J Clin Invest 1951 Nov; 30(5): 672–3Google Scholar
  120. 120.
    Shepherd AM, Ludden TM, McNay JL, et al. Hydralazine kinetics after single and repeated oral doses. Clin Pharmacol Ther 1980 Dec; 28(6): 804–11PubMedGoogle Scholar
  121. 121.
    Ludden TM, Shepherd AM, McNay JL, et al. Hydralazine kinetics in hypertensive patients after intravenous administration. Clin Pharmacol Ther 1980 Dec; 28(6): 736–42PubMedGoogle Scholar
  122. 122.
    O’Malley K, Segal JL, Israili ZH, et al. Duration of hydralazine action in hypertension. Clin Pharmacol Ther 1975 Nov; 18 (5 Pt 1): 581–6PubMedGoogle Scholar
  123. 123.
    Gerber JG, Nies AS. Antihypertensive agents and the drug therapy of hypertension. In: Goodman LS, Gilman A, Gilman AG, editors. Goodman and Gilman’s the pharmacological basis of therapeutics. 8th ed. New York (NY): Pergamon Press, 1990: 784–813Google Scholar
  124. 124.
    Straka RJ, Lohr B, Borchardt-Phelps P, et al. Antihypertensive agents. In: Irwin RS, Cerra FB, Rippe JM, editors. Intensive care medicine. 3rd ed. Boston (MA): Little Brown, 1996: 2286–317Google Scholar
  125. 125.
    Bussmann WD, Kenedi P, von Mengden HJ, et al. Comparison of nitroglycerin with nifedipine in patients with hypertensive crisis or severe hypertension. Clin Investig 1992 Dec; 70(12): 1085–8PubMedGoogle Scholar
  126. 126.
    Parke Davis Pharmaceuticals Ltd. Nitrostat® (nitroglycerin tablets, USP) prescribing information [online]. Available from URL: http://www.pfizer.com/pfizer/download/uspi_nitrostat.pdf [Accessed 2007 Jul 16]
  127. 127.
    Friederich JA, Butterworth JFT. Sodium nitroprusside: twenty years and counting. Anesth Anaig 1995 Jul; 81(1): 152–62Google Scholar
  128. 128.
    Robin ED, McCauley R. Nitroprusside-related cyanide poisoning: time (long past due) for urgent, effective interventions. Chest 1992 Dec; 102(6): 1842–5PubMedGoogle Scholar
  129. 129.
    Hartmann A, Buttinger C, Rommel T, et al. Alteration of intracranial pressure, cerebral blood flow, autoregulation and carbondioxide-reactivity by hypotensive agents in baboons with intracranial hypertension. Neurochirurgia (Stuttg) 1989 Mar; 32(2): 37–43Google Scholar
  130. 130.
    Kondo T, Brock M, Bach H. Effect of intra-arterial sodium nitroprusside on intracranial pressure and cerebral autoregulation. Jpn Heart J 1984 Mar; 25(2): 231–7PubMedGoogle Scholar
  131. 131.
    Griswold WR, Reznik V, Mendoza SA. Nitroprusside-induced intracranial hypertension. JAMA 1981 Dec 11; 246(23): 2679–80PubMedGoogle Scholar
  132. 132.
    Anile C, Zanghi F, Bracali A, et al. Sodium nitroprusside and intracranial pressure. Acta Neurochir (Wien) 1981; 58(3-4): 203–11Google Scholar
  133. 133.
    Mann T, Cohn PF, Holman LB, et al. Effect of nitroprusside on regional myocardial blood flow in coronary artery disease: results in 25 patients and comparison with nitroglycerin. Circulation 1978 Apr; 57(4): 732–8PubMedGoogle Scholar
  134. 134.
    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 May 13; 306(19): 1129–35PubMedGoogle Scholar
  135. 135.
    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 Jun; 7(6): 653–62PubMedGoogle Scholar
  136. 136.
    Pasch T, Schulz V, Hoppelshauser G. Nitroprusside-induced formation of cyanide and its detoxication with thiosulfate during deliberate hypotension. J Cardiovasc Pharmacol 1983 Jan–Feb; 5(1): 77–85PubMedGoogle Scholar
  137. 137.
    Hall VA, Guest JM. Sodium nitroprusside-induced cyanide intoxication and prevention with sodium thiosulfate prophylaxis. Am J Crit Care 1992 Sep; 1(2): 19–25; quiz 6-7PubMedGoogle Scholar
  138. 138.
    Izumi Y, Benz AM, Clifford DB, et al. Neurotoxic effects of sodium nitroprusside in rat hippocampal slices. Exp Neurol 1993 May; 121(1): 14–23PubMedGoogle Scholar
  139. 139.
    Niknahad H, O’Brien PJ. Involvement of nitric oxide in nitroprusside-induced hepatocyte cytotoxicity. Biochem Pharmacol 1996 Apr 26; 51(8): 1031–9PubMedGoogle Scholar
  140. 140.
    Gobbel GT, Chan TY, Chan PH. Nitric oxide- and superoxide-mediated toxicity in cerebral endothelial cells. J Pharmacol Exp Ther 1997 Sep; 282(3): 1600–7PubMedGoogle Scholar
  141. 141.
    Nakamura Y, Yasuda M, Fujimori H, et al. Cytotoxic effect of sodium nitroprusside on PC12 cells. Chemosphere 1997 Feb; 34(2): 317–24PubMedGoogle Scholar
  142. 142.
    Rauhala P, Khaldi A, Mohanakumar KP, et al. Apparent role of hydroxyl radicals in oxidative brain injury induced by sodium nitroprusside. Free Radic Biol Med 1998 May; 24(7-8): 1065–73PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  1. 1.The University of Texas Health Science Center at HoustonHoustonUSA
  2. 2.The University of Texas Medical Branch at GalvestonGalvestonUSA
  3. 3.St Luke’s Episcopal Hospital/Texas Heart InstituteHoustonUSA
  4. 4.HoustonUSA

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