From the Guidelines
For hypertensive urgency, oral medications that can be given include labetalol (200-400 mg), captopril (25 mg), clonidine (0.1-0.2 mg), or amlodipine (10 mg) 1. The goal is to gradually lower blood pressure over 24-48 hours, not rapidly, as sudden drops can cause organ damage.
- Labetalol works as both an alpha and beta-blocker, reducing peripheral resistance and heart rate.
- Captopril is an ACE inhibitor that blocks angiotensin II formation.
- Clonidine reduces sympathetic outflow from the brain.
- Amlodipine is a calcium channel blocker that relaxes vascular smooth muscle. When administering these medications, monitor blood pressure every 30-60 minutes initially. Patients should be observed for at least several hours after administration to ensure blood pressure is decreasing appropriately without dropping too rapidly. It's essential to distinguish hypertensive urgency (severely elevated BP without organ damage) from hypertensive emergency, which requires IV medications and immediate hospitalization. According to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension, in severe hypertension, drug treatment with i.v. labetalol, oral methyldopa, or nifedipine is recommended 1. Intravenous hydralazine is a second-line option. The most recent and highest quality study, the 2024 ESC guidelines, prioritizes the use of these medications for hypertensive urgency, focusing on gradual blood pressure reduction to minimize the risk of organ damage 1.
From the FDA Drug Label
In controlled clinical studies, metoprolol has been shown to be an effective antihypertensive agent when used alone or as concomitant therapy with thiazide-type diuretics, at oral dosages of 100 to 450 mg daily
- Metoprolol can be used for hypertensive urgency, with oral dosages of 100 to 450 mg daily 2.
- Captopril is also an option, but the provided text does not specify its use for hypertensive urgency, only its mechanism of action and pharmacokinetics 3.
- Nifedipine is another option, but the label only describes its composition and formulation, without explicitly stating its use for hypertensive urgency 4.
From the Research
Oral Medications for Hypertensive Urgency
- Nifedipine, a calcium channel blocker, is an effective antihypertensive agent for the treatment of hypertensive urgencies and emergencies, producing a prompt, safe, predictable, and consistent reduction in systemic arterial pressure with minimal adverse effects 5, 6, 7.
- The overall efficacy of nifedipine in reaching goal blood pressure approaches 98% with a 10 to 20 mg dose 5.
- Angiotensin-converting enzyme inhibitors have been shown to have a superior effect in treating hypertensive urgencies, with lower frequency of adverse effects compared to calcium channel blockers 8.
- Clonidine has been found to be a more effective therapeutic for hypertensive urgency compared to captopril, with patients relieving sooner and experiencing fewer side effects 9.
- Common oral medications used for hypertensive urgency include:
- Nifedipine
- Angiotensin-converting enzyme inhibitors (e.g. captopril)
- Clonidine
- Adverse effects of these medications may include: