Clinical presentation

Target BP

Recommended drugs

Accelerated (malignant) hypertension

MAP reduced by 20%-25%

– First choice: Labetalol or nicardipinea

– Second choice: Nitroprusside or urapidila

Hypertensive encephalopathy

MAP reduced by 20%-25%

– First choice: Labetalol or nicardipinea

– Second choice: Nitroprusside

Acute coronary event

SBP <140 mm Hg

– First choice: Nitroglycerine or labetalol

– Second choice: Urapidila

Acute cardiogenic pulmonary edema

SBP <140 mm Hg

– First choice: Nitroglycerine or nitroprusside (with loop diuretic)

– Second choice: Urapidila (with loop diuretic)

Acute aortic dissection

SBP <120, HR <60 beats/min

– First choice: Beta-blocker (esmolol, propranolol); add nitroglycerine, nitroprusside, or nicardipinea if needed

– Second choice: Labetalol or metoprolol

Eclampsia and severe preeclampsia/HELLP

SBP <160 mm Hg, DBP <105 mm Hg

– Magnesium sulfate plus one or more of labetalol, nicardipine,a or oral nifedipine

– Consider immediate delivery

Notes:

1) Treatment in the ICU or an equivalent setting is mandatory.

2) Drugs are usually delivered IV.

3) BP reduction should occur immediately (or within several hours in case of accelerated/malignant hypertension).

a Not available in Canada.