Pharmacological management of hypertensive emergencies and urgencies: focus on newer agents

Abstract

Agents such as sodium nitroprusside, nitroglycerin and hydralazine have been used for many years as first-line options for patients with hypertensive emergencies, although their potential adverse effects and difficulties in use were well known. With time, equally potent and less toxic alternatives, including nicardipine, fenoldopam, labetalol and esmolol are increasingly used worldwide. Recently, clevidipine, a third-generation dihydropyridine calcium-channel blocker with unique pharmacodynamic and pharmacokinetic properties was added to our therapeutic armamentarium and was shown in clinical trials to reduce mortality when compared with nitroprusside. In view of such evidence, a change in pharmacological treatment practices for hypertensive crises toward newer and safer agents is warranted.

Urapidil: Modern Medicine for the Treatment of Hypertensive Crises

“…Эффективность лабеталола (α-и β-адреноблокатор) для лечения гипертонического криза доказана во мно-гих клинических исследованиях [4]. Однако примене-ние этого препарата может быть ограничено наличием у пациента нарушений проводимости, сердечной не-достаточности, бронхиальной обструкции.…”

“…Рациональная Фармакотерапия в Кардиологии 2013;9 (4) Урапидил в лечении гипертонических кризов В новых рекомендациях тактика ведения пациентов с гипертоническим кризом по-прежнему описана очень кратко. Конкретный алгоритм действий по снижению АД определен только у пациентов с гипертоническим кри-зом, осложненным развитием острой левожелудочко-вой недостаточности и расслаивающей аневризмы.…”

Antihypertensive Bridge Therapy by Continuous Drug Infusion With an Elastomeric Pump in Device-Resistant Hypertension

“…3 Esmolol is a short-acting β1-blocker, available as 100 mg/10 mL, has an acceptable chemical stability of 7 days in solution. 7 Its dosing is body weight dependent, thus a 576 mL of solution/d is required to obtain a concentration of at least 50 μg/kg per hour, that makes it unsuitable for elastomeric pumps.…”

“…7 Its dosing is body weight dependent, thus a 576 mL of solution/d is required to obtain a concentration of at least 50 μg/kg per hour, that makes it unsuitable for elastomeric pumps. 3 Labetalol, a combined α1-and unselective β-blocker used in hypertensive emergencies, is available as 100 mg in 20 mL vials. 3 The maximal drug concentration in solution is 1 mg/mL and an efficacious effect can be obtained at doses of ≈50 mg/h, unsuitable for elastomeric pump.…”

“…3 Labetalol, a combined α1-and unselective β-blocker used in hypertensive emergencies, is available as 100 mg in 20 mL vials. 3 The maximal drug concentration in solution is 1 mg/mL and an efficacious effect can be obtained at doses of ≈50 mg/h, unsuitable for elastomeric pump. The angiotensin-converting enzyme inhibitor, enalaprilat, has no indications for continuous infusion.…”