The therapeutic goal is to minimize target organ damage safely by rapid recognition of the problem and early initiation of appropriate antihyperten- sive treatment. 2. Compelling conditions requiring rapid lowering of SBP, usually to <140 mm Hg, in the first hour of treatment Table 19. Intravenous Antihypertensive Drugs for Treatment of Hypertensive Emergencies Class Drug(s) Usual Dose Range Comments CCB dihydropyridines Nicardipine Initial 5 mg/h, increasing every 5 min by 2.5 mg/h to maximum 15 mg/h. Contraindicated in advanced aortic stenosis; no dose adjustment needed for elderly. Clevidipine Initial 1 2 mg/h, doubling every 90 s until BP approaches target, then increasing by less than double every 5 10 min; maximum dose 32 mg/h; maximum duration 72 h. Contraindicated in patients with soybean, soy product, egg, and egg product allergy and in patients with defective lipid metabolism (eg, pathological hyperlipidemia, lipoid nephrosis or acute pancreatitis). Use low-end dose range for elderly patients. Vasodilators Nitric- oxide dependent Sodium nitroprusside Initial 0.3 0.5 mcg/kg/min; increase in increments of 0.5 mcg/kg/min to achieve BP target; maximum dose 10 mcg/kg/min; duration of treatment as short as possible. For infusion rates 4 10 mcg/kg/min or duration >30 min, thiosulfate can be coadministered to prevent cyanide toxicity. Intra-arterial BP monitoring recommended to prevent overshoot. Lower dosing adjustment required for elderly. Tachyphylaxis common with extended use. Cyanide toxicity with prolonged use can result in irreversible neurological changes and cardiac arrest. Nitroglycerin Initial 5 mcg/min; increase in increments of 5 mcg/min every 3 5 min to a maximum of 20 mcg/min. Use only in patients with acute coronary syndrome and/or acute pulmonary edema. Do not use in volume-depleted patients. Vasodilators direct Hydralazine Initial 10 mg via slow IV infusion (maximum initial dose 20 mg); repeat every 4 6 h as needed. 