Adenosine is NOT Used in Hypertensive Emergencies
Adenosine is not a treatment for hypertensive emergencies and should never be used for this indication. In fact, adenosine can cause dangerous hypertension as a side effect and is contraindicated in patients with cardiovascular instability 1.
Why This Misconception Exists
There appears to be confusion about adenosine's role in cardiovascular medicine. While adenosine is used for specific cardiac arrhythmias (particularly supraventricular tachycardia), it has no role in managing elevated blood pressure 2.
Actual First-Line Agents for Hypertensive Emergencies
The evidence-based medications for hypertensive emergencies are:
Primary Recommendations
Labetalol is the first-line agent for most hypertensive emergencies, including malignant hypertension, hypertensive encephalopathy, acute ischemic stroke, and acute hemorrhagic stroke 3, 4, 5.
Nicardipine serves as an effective alternative to labetalol and is particularly useful in patients with contraindications to beta-blockade 3, 4.
Nitroprusside or nitroglycerin are preferred for acute coronary events and acute cardiogenic pulmonary edema 3, 5.
Clinical Context Matters
For acute coronary events: Nitroglycerin is first-line, with target systolic BP <140 mmHg 3.
For acute aortic dissection: Esmolol combined with nitroprusside or nitroglycerin, targeting systolic BP <120 mmHg and heart rate <60 bpm 3.
For eclampsia/preeclampsia: Labetalol or nicardipine with magnesium sulfate, targeting systolic BP <160 mmHg and diastolic BP <105 mmHg 3.
Why Adenosine is Dangerous in This Context
Cardiovascular Risks
Adenosine can induce clinically significant increases in systolic and diastolic blood pressure, which may last for several hours 1.
It causes significant hypotension as a potent peripheral vasodilator, creating unpredictable blood pressure fluctuations 1.
Fatal and nonfatal cardiac arrest, sustained ventricular tachycardia, and myocardial infarction have occurred following adenosine administration 1.
Specific Contraindications
Adenosine should be avoided in patients with cardiovascular instability or acute myocardial ischemia, which often coexist with hypertensive emergencies 1.
It can cause cerebrovascular accidents (both hemorrhagic and ischemic), seizures, and severe bronchoconstriction 1.
Common Pitfall to Avoid
Never confuse adenosine (used for arrhythmias) with adenosine receptor modulators or other antihypertensive agents. The appropriate management of hypertensive emergencies requires intravenous medications with predictable, titratable effects on blood pressure—characteristics that adenosine completely lacks 3, 6.