Thread by @akhadilkarMD

As a Cardiology fellow, we get a lot of consults for hypertensive urgency/emergency.

Part 3B: Therapy

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Fenoldopam:
- Used mainly by anesthesiologists to control BP intra-operatively
- Selective peripheral dopamine-1 receptor agonist approved for the management of severe HTN
- Arterial vasodilator w/ relatively short half-life
- Contraindicated w/ glaucoma b/c can raise ICP

Nicardipine:
- Dihydropyridine calcium channel blocker that inhibits vascular smooth muscle contraction
- Little to no activity on the AV or sinus node
- Does not raise ICP and reduces cerebral ischemia
- Contraindicated w/ advanced HF, acute MI, and renal failure

Clevidipine:
- Short-acting dihydropyridine calcium-channel blocker administered as a continuous IV infusion and does not cause reflex tachycardia
- Shorter half-life than Nicardipine
- Contraindicated in patients w/ disordered lipid metabolism, use w/ caution with propofol

Enalaprilat:
- Short-acting IV ACE inhibitor that lowers BP abruptly
- Not widely used b/c it can precipitate hypotension, particularly in volume-depleted patients or those with renal artery stenosis
- ACE are first-line therapy for scleroderma renal crisis (*commonly tested)

Hydralazine:
- Role of IV hydralazine should be used in hypertensive emergency in pregnant women w/ pre-eclampsia and eclampsia
- Direct arterial vasodilator w/o effect on venous compliance
- Crosses the utero-placental barrier w/ minimal effects on the fetus

Hydralazine:
- Decreases SVR. It can induce a compensatory tachycardia.
- Can exacerbate angina and contraindicated with ongoing coronary ischemia, aortic dissection, or increased ICP.

*Not to use for medical advice and always discuss with your fellow or medical attending*

In clinical practice, among these medications, Hydralazine and Nicardipine are commonly used. Stay tuned for part 4: Clinical Presentations, will be high yield!