II. Precautions
- IV Antihypertensive use in non-cardiac related adult hospitalizations is associated with HARM
- Acute Kidney Injury (RR 1.5)
- Myocardial injury (RR 2)
- Inpatient mortality (RR 2)
- Increased risk of Cerebrovascular Accident
- Higher risk of escalation to ICU care
- Associated with prolonged hospital length of stay
- Kondrad (2025) Am Fam Physician 112(1): 81-2 [PubMed]
III. Preparations: Calcium Channel Blockers
-
Nicardipine
- Start: 5 mg/hour
- Maximum: 15 mg/hour
- Titrate
- Increase by 2.5 mg/hour every 5-15 minutes until Blood Pressure goal reached or maximum reached (15 mg/hour)
- Once goal Blood Pressure achieved, titrate down towards 3 mg/hour as long as Blood Pressure is controlled
- Exercise caution when titrating dose in renal Impairment
- Transitioning from IV Nicardipine to oral agents
- Administer oral Antihypertensive 1 hour after discontinuing IV infusion
-
Clevidipine
- Start: 1-2 mg/hour IV infusion
- Titrate: Double dose (as often as every 90 seconds, then every 5-10 min) until approaching target Blood Pressure
- Blood Pressure drops 2-4 mmHg for every 1-2 mg/h
- Target
- Typical maintenance dose 4-6 mg/h
- Half of maximal effect reached at 10 mg/h
- Maximum
- Typical maximum dose 16 mg/h
- Absolute maximum dose 32 mg/h
IV. Medications: Direct Acting Vasodilators IV
-
Hydralazine (Apresoline)
- Dose: 10-40 mg IV/IM q4-6h
-
Diazoxide (Hyperstat)
- Dose: 1-3 mg/kg up to 150 mg IV q5-15 min
- Nitroprusside Sodium (Nipride)
- Nitroglycerin Drip
V. Medications: Beta Blockers IV
-
Esmolol (Brevibloc)
- Half-Life: 9 minutes
- Preparation: 5g in 500 ml (10 mg/ml)
- Load: 500 ug/kg over 1 minute (70 kg: 35 mg, 3.5 ml)
- Infusion: 50-200 ug/kg/min IV (70 kg: 40 ml/h)
-
Labetalol (Trandate)
- Start: 20 mg IV
- Titrate: 40-80 mg every 10 min up to 300 mg
-
Metoprolol (Lopressor)
- Start: 5 mg increments IV
- Titrate: 5 mg IV q5-15 minutes to maximum of 15 mg