-receptor selective agonist Fenoldopam Initial 0.1 0.3 mcg/kg/min; may be increased in increments of 0.05 0.1 mcg/kg/min every 15 min until target BP is reached. Maximum infusion rate 1.6 mcg/ kg/min. Contraindicated in patients at risk of increased intraocular pressure (glaucoma) or intracranial pressure and those with sulfite allergy. ACE inhibitor Enalaprilat Initial 1.25 mg over a 5-min period. Doses can be increased up to 5 mg every 6 h as needed to achieve BP target. Contraindicated in pregnancy and should not be used in acute MI or bilateral renal artery stenosis. Mainly useful in hypertensive emergencies associated with high plasma renin activity. Dose not easily adjusted. Relatively slow onset of action (15 min) and unpredictability of BP response. BP indicates blood pressure; CCB, calcium channel blocker; HF, heart failure; IV, intravenous; and MI, myocardial infarction. include aortic dissection, severe preeclampsia or eclamp- sia, and pheochromocytoma with hypertensive crisis. 3. There is no RCT evidence comparing different strategies to reduce BP, except in patients with ICH.S11.2-9,S11.2-13 Neither is there RCT evidence to suggest how rapidly or how much BP should be lowered in a hypertensive emergency.S11.2-9 However, clinical experience indicates that excessive re- duction of BP may cause or contribute to renal, cerebral, or coronary ischemia and should be avoided. Thus, com- prehensive dosing of intravenous or even oral antihyper- tensive agents to rapidly lower BP is not without risk. Oral loading doses of antihypertensive agents can engender cumulative effects, causing hypotension after discharge from the emergency department or clinic. 11.3. Cognitive Decline and Dementia Recommendation for Prevention of Cognitive Decline and Dementia References that support the recommendation are summarized in Online Data Supplement 56. COR LOE Recommendation IIa B-R 1. 