What is the use of Hydralazine (Apresoline)?

From the Guidelines

Hydralazine is a direct-acting vasodilator medication primarily used to treat high blood pressure and heart failure, with a typical starting dose of 10 mg via slow IV infusion for acute treatment, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

Key Points

• Hydralazine works by relaxing the smooth muscle in blood vessel walls, causing them to widen and reduce blood pressure.
• The medication is often used in combination with other agents, such as isosorbide dinitrate (BiDil), to improve cardiac function in patients with heart failure, particularly in African American patients who show enhanced response to this combination.
• Common side effects of hydralazine include headache, dizziness, flushing, palpitations, and fluid retention.
• Long-term use of hydralazine requires monitoring, as it can cause a lupus-like syndrome in some patients, characterized by joint pain, fever, and skin rash.
• Hydralazine should be used cautiously in patients with coronary artery disease, as it may cause reflex tachycardia.
• Blood pressure monitoring is essential when starting or adjusting hydralazine therapy, and patients should take it consistently throughout the day to maintain stable blood pressure control.

Use in Pregnancy-Related Hypertension

• Hydralazine is particularly valuable in pregnancy-related hypertension, as it has a well-established safety profile for both mother and fetus.
• The medication can be used to treat severe hypertension in pregnant women, with a typical dose of 5 mg IV bolus, followed by 10 mg every 20 to 30 minutes, as needed, to a maximum of 25 mg 1.

Important Considerations

• Hydralazine is not typically used as a first-line agent for acute treatment of hypertensive emergencies, due to its unpredictability of response and prolonged duration of action 1.
• The medication should be used in combination with other agents, such as diuretics and beta-blockers, to minimize adverse effects and optimize blood pressure control.
• Patients with resistant hypertension may require combination therapy with hydralazine and other agents, such as ACE inhibitors, calcium channel blockers, or centrally acting agonists, to achieve adequate blood pressure control 1.

From the FDA Drug Label

In hypertensive patients with normal kidneys who are treated with hydralazine, there is evidence of increased renal blood flow and a maintenance of glomerular filtration rate. The primary use of Hydralazine (Apresoline) is for the treatment of hypertension.

• It is used to lower blood pressure in patients with high blood pressure.
• The drug has been shown to increase renal blood flow and maintain glomerular filtration rate in hypertensive patients with normal kidneys 2, 3.

From the Research

Use of Hydralazine (Apresoline)

• Hydralazine is used to treat severe asymptomatic hypertension and hypertensive crisis 4, 5
• It is a direct-acting vasodilator that lowers blood pressure by decreasing total peripheral resistance 6
• Hydralazine can be administered orally or intravenously, with oral administration being the most common 4
• It is often used in combination with other antihypertensive medications, such as beta-adrenergic blockers and diuretics 6, 7
• The efficacy and safety of hydralazine have been evaluated in several studies, with results showing that it can effectively lower blood pressure and reduce the risk of cardiovascular events 4, 5, 8

Administration and Dosage

• The dosage of hydralazine varies depending on the patient's condition and response to treatment 5, 7
• Intravenous administration of hydralazine is typically used in emergency situations, such as hypertensive crisis 5
• Oral administration is often used for long-term management of hypertension 4, 8
• The combination of hydralazine with other antihypertensive medications can enhance its effectiveness and reduce side effects 6, 7

Side Effects and Interactions

• Hydralazine can cause side effects such as reflex tachycardia, hemolytic anemia, vasculitis, glomerulonephritis, and a lupus-like syndrome 8
• It can also interact with other medications, such as beta-adrenergic blockers and diuretics, to enhance its effects or increase the risk of side effects 6, 7
• Patients receiving hydralazine should be closely monitored for signs of adverse effects and interactions 4, 5