Page 56 - GUIAS ESC ESH 2018

56 ESC/ESH Guidelines

Table 32 Drug types, doses, and characteristics for treatment of hypertension emergencies

Drug Onset of action Duration Dose Contraindications Adverse effects
of action

Esmolol 1–2 min 10–30 min 0.5–1 mg/kg as bolus; 50–300 Second or third-degree AV Bradycardia
mg/kg/min as continuous block, systolic heart failure,
infusion asthma, bradycardia

Metoprolol 1–2 min 5–8 h 15 mg i.v., usually given as 5 mg Second or third-degree AV Bradycardia
i.v., and repeated at 5 min inter- block, systolic heart failure,
vals as needed asthma, bradycardia
Labetalol 5–10 min 3–6 h 0.25–0.5 mg/kg; 2–4 mg/min Second or third-degree AV Bronchoconstriction,
until goal BP is reached, there- block; systolic heart failure, foetal bradycardia
after 5–20 mg/h asthma, bradycardia
Fenoldopam 5–15 min 30–60 min 0.1 mg/kg/min, increase every Caution in glaucoma
15 min until goal BP is reached
Clevidipine 2–3 min 5–15 min 2 mg/h, increase every 2 min Headache, reflex
with 2 mg/h until goal BP tachycardia
Nicardipine 5–15 min 30–40 min 5–15 mg/h as continuous infu- Liver failure Headache, reflex
sion, starting dose 5 mg/h, tachycardia
increase every 15–30 min with
2.5 mg until goal BP, thereafter
decrease to 3 mg/h
Nitroglycerine 1–5 min 3–5 min 5–200 mg/min, 5 mg/min Headache, reflex
increase every 5 min tachycardia
Nitroprusside Immediate 1–2 min 0.3–10 mg/kg/min, increase by Liver/kidney failure Cyanide intoxication
0.5 mg/kg/min every 5 min until (relative)
goal BP
Enalaprilat 5–15 min 4–6 h 0.62–1.25 mg i.v. History of angioedema

Urapidil 3–5 min 4–6 h 12.5–25 mg as bolus injection;
5–40 mg/h as continuous
infusion
Clonidine 30 min 4–6 h 150–300 mg i.v. over 5–10 min Sedation, rebound
hypertension

Phentolamine 1–2 min 10–30 min 0.5–1 mg/kg bolus injections Tachyarrhythmias,
OR 50–300 mg/kg/min as con- chest pain
tinuous infusion

AV = atrioventricular; BP = blood pressure; i.v. = intravenous.

.
8.4 White-coat hypertension . . . as well as an overall increased risk of CV events. 68,410–412 It is recom-
As discussed in section 4, white-coat hypertension is defined as an . . . mended that people with white-coat hypertension should have an
elevated office BP despite a normal out-of-office BP. White-coat . . . accurate assessment of their CV risk profile, including a search for
hypertension may be present in many people with an increased office . . . HMOD. Office and out-of-office BP (both home and ambulatory BP)
BP, with a maximum in grade 1 hypertension, and very old people . . . should be measured frequently, e.g. no less than every 2 years.
(>50%). Compared with normotensive people, white-coat hyperten- . . . . Treatment should consider lifestyle changes to reduce the elevated
sion is associated with an increased prevalence of dysmetabolic risk . . . CV risk. 85,86,89
factors and asymptomatic organ damage. It is also associated with a . . . Whether or not patients with white-coat hypertension should
greater risk of developing type 2 diabetes and sustained hypertension, . . receive antihypertensive drugs is unresolved. In white-coat

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