Terapi Anti Hipertensi Untuk Hipertensi Emergensi
Patients with severe hypertension (> 220/120 mm Hg) and
signs and symptoms of encephalopathy, acute myocardial ischemic syndromes,
stroke, pulmonary edema, or aortic dissection should be treated emergently to
achieve rapid reduction of their blood pressure. Because of its
rapid onset and short duration of therapy, which allow for smoother titration of
blood pressure, intravenous sodium nitroprusside is the treatment of choice.
Patients should be admitted to the intensive care unit and monitored closely
during therapy. The aim is to reduce blood pressure very quickly within the
first hour or two after presentation but to avoid hypotension. Patients must be
monitored for thiocyanate toxicity if therapy is prolonged. An alternative is
intravenous fenoldopam, a selective dopamine-1 receptor agonist. It has a
similar antihypertensive profile to nitroprusside with a rapid predictable onset
of action, short half-life (9.8 min), and few side effects at effective doses.
There is a linear correlation between fenoldopam infusion rate and blood
pressure lowering. Its use still requires monitoring in the intensive care
unit.
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If aortic dissection is present, a short-acting beta-blocker such as esmolol should be added
to decrease shear forces in the aorta. Intravenous labetalol is highly effective
and can also be used. Oral immediate-release clonidine and ACEI are effective in
rapidly reducing blood pressure and can be added orally. Oral immediate-release
nifedipine may cause unpredictable hypotension and should not be used.
Current Diagnosis & Treatment Cardiology 3rd Edition (McGraw-Hill) 2009