What is the treatment for severe hypertension with Labetalol?

From the Guidelines

For a patient with severe hypertension (BP 210/120), labetalol is recommended as a first-line treatment, with an initial dose of 10-20 mg IV over 1-2 minutes, which can be repeated or doubled every 10 minutes, with a maximum total dose of 300 mg 1.

Treatment Approach

The goal of treatment is to carefully lower the blood pressure to prevent further complications while avoiding excessive reduction that could compromise cerebral perfusion.

• The initial dose of labetalol can be followed by additional doses of 20-80 mg every 10 minutes until the target blood pressure is achieved.
• Alternatively, a continuous infusion can be started at 1-2 mg/minute after the initial bolus, titrated according to blood pressure response.
• It is essential to monitor blood pressure and heart rate closely during administration, as labetalol can cause bradycardia and hypotension.

Considerations

• Labetalol works through dual alpha-1 and beta-adrenergic receptor blockade, providing balanced vasodilation without reflex tachycardia.
• The medication should be used cautiously in patients with asthma, COPD, heart failure, or diabetes, and is contraindicated in those with severe bradycardia, heart block, or cardiogenic shock.
• Once the patient is stabilized, they can be transitioned to oral labetalol, usually starting at 100-200 mg twice daily, with gradual adjustments up to 200-400 mg twice daily as needed.

Evidence Support

The recommendation for using labetalol in severe hypertension is supported by guidelines from reputable sources, including the American Heart Association 1, which emphasize the importance of careful blood pressure management in acute ischemic stroke patients.

• These guidelines suggest that labetalol is a preferred agent due to its ease of titration and minimal effects on cerebral blood vessels.
• The guidelines also highlight the need for close monitoring of blood pressure and heart rate during treatment with labetalol.

From the FDA Drug Label

In a clinical pharmacologic study in severe hypertensives, an initial 0. 25 mg/kg injection of labetalol HCl, administered to patients in the supine position, decreased blood pressure by an average of 11/7 mmHg. Additional injections of 0.5 mg/kg at 15-minute intervals up to a total cumulative dose of 1.75 mg/kg of labetalol HCl caused further dose-related decreases in blood pressure. Some patients required cumulative doses of up to 3. 25 mg/kg. Labetalol HCl administered as a continuous intravenous infusion, with a mean dose of 136 mg (27 to 300 mg) over a period of 2 to 3 hours (mean of 2 hours and 39 minutes) lowered the blood pressure by an average of 60/35 mmHg

The treatment for severe hypertension with Labetalol is an initial dose of 0.25 mg/kg administered intravenously, followed by additional doses of 0.5 mg/kg at 15-minute intervals, up to a total cumulative dose of 1.75 mg/kg or more, depending on the patient's response. Alternatively, Labetalol can be administered as a continuous intravenous infusion, with a mean dose of 136 mg over a period of 2 to 3 hours. Labetalol can lower blood pressure by an average of 60/35 mmHg 2.

• Key points:
  • Initial dose: 0.25 mg/kg
  • Additional doses: 0.5 mg/kg at 15-minute intervals
  • Cumulative dose: up to 1.75 mg/kg or more
  • Infusion dose: 136 mg over 2 to 3 hours
  • Blood pressure reduction: 60/35 mmHg on average 2

From the Research

Treatment for Severe Hypertension with Labetalol

• Labetalol is a combined alpha- and beta-adrenoceptor blocking agent used in the treatment of hypertension 3.
• It is effective in reducing blood pressure in patients with severe hypertension, including those with hypertensive emergencies 4, 5, 6.
• The antihypertensive effects of labetalol can be achieved through oral or intravenous administration, with intravenous administration providing rapid blood pressure reduction 4, 5, 6.
• The initial dose of intravenous labetalol can be a mini-bolus injection of 20 mg, followed by repeated incremental doses of 20 to 80 mg given at 10-minute intervals to achieve the desired blood pressure reduction 4.
• Continuous intravenous infusion of labetalol is also an effective alternative for severe hypertension, with an initial infusion rate of 2 mg/min that can be adjusted according to the patient's response 6.

Administration and Dosage

• The dosage of labetalol required to achieve the therapeutic effect may be less in patients who have been pretreated with antihypertensive medication, but the duration of action may be shorter 4.
• Oral labetalol can be started at an initial dosage of 100 or 200 mg twice daily, with increases every 2 days until the desired blood pressure reduction is achieved or a maximum daily dosage of 2400 mg is reached 5.
• The effectiveness and safety of labetalol have been demonstrated in various studies, with common side effects including posture-related dizziness, gastrointestinal disturbances, and tiredness 3, 4, 5, 6.

Efficacy and Safety

• Labetalol has been shown to be effective in reducing blood pressure in patients with severe hypertension, including those with hypertensive emergencies, with a rapid onset of action and a duration of effect that can last for 12 hours or more 4, 5.
• The safety of labetalol has been demonstrated in various studies, with no serious adverse effects encountered in patients with concomitant diagnoses of acute left ventricular failure, myocardial infarction, stable congestive heart failure, atrial fibrillation, angina pectoris, acute stroke, transient ischemic attack, or encephalopathy 4.