From the Guidelines
For a blood pressure of 185/100, immediate treatment with intravenous labetalol is recommended to reduce the risk of cardiovascular complications, aiming for a target blood pressure reduction of 15% within 1 hour, as indicated for acute ischemic stroke with indication for thrombolytic therapy 1.
Clinical Presentation and Treatment
The clinical presentation of a patient with a blood pressure of 185/100 is critical in determining the appropriate treatment approach. According to the European Heart Journal study 1, for acute ischemic stroke with indication for thrombolytic therapy and blood pressure >185 mmHg systolic or >110 mmHg diastolic, labetalol is the first-line treatment.
- The goal is to lower the mean arterial pressure (MAP) by 15% within 1 hour.
- Alternative treatments include nicardipine and nitroprusside.
Rationale for Treatment Choice
The choice of labetalol as the first-line treatment is based on its ability to effectively lower blood pressure while maintaining cerebral blood flow, which is crucial in the context of acute ischemic stroke 1.
- Labetalol is preferred over nitroprusside because it does not increase intracranial pressure and leaves cerebral blood flow relatively intact for a given blood pressure reduction.
- The administration of ACE-inhibitors may also be considered, but they must be started at a very low dose to prevent sudden decreases in blood pressure, and intravenous saline infusion can be used to correct precipitous blood pressure falls if necessary 1.
Monitoring and Adjustment
Regular monitoring of blood pressure is essential to adjust the treatment as needed and to ensure that the target blood pressure is achieved.
- The patient's response to treatment should be closely monitored, and adjustments made to the dosage or type of medication as necessary to maintain a safe and effective blood pressure reduction.
- It is also important to consider the patient's overall clinical condition, including any signs of end-organ damage or other comorbidities, when determining the appropriate treatment approach 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for 185/100 Blood Pressure
- The given blood pressure of 185/100 is considered a hypertensive crisis, which is defined as an acute increase in blood pressure >180/120 mmHg 2, 3, 4.
- According to the European and North-American guidelines, a blood pressure of >180/120 mmHg is considered a hypertensive crisis, and immediate lowering of blood pressure is mandatory to prevent further progression of target organ damage 2.
- The treatment for hypertensive crisis depends on the presence of acute hypertensive target organ damage, such as stroke, myocardial infarction, or heart failure 2.
- In the absence of target organ damage, the condition is considered a hypertensive urgency, and blood pressure should be lowered within 24 to 48 hours to avoid hypertensive target organ damage 2.
- For hypertensive emergencies, immediate lowering of blood pressure (about 25% within one to two hours) in an intensive care setting is mandatory 2.
- Nicardipine and clevidipine are both dihydropyridine calcium channel blockers that can be used to lower blood pressure in hypertensive crisis 4, 5, 6.
- A study comparing nicardipine and clevidipine found that nicardipine achieved a systolic blood pressure goal of <160 mm Hg at 2-6 hours significantly more often than the clevidipine group 4.
- Clevidipine is effective in the treatment of acute perioperative hypertension during cardiac surgery and hypertensive emergencies in adults, with a rapid onset and short duration of action 5.
- Nicardipine is also an effective treatment for stable effort angina and rest angina due to coronary artery spasm, and mild to moderate hypertension, with a relatively well-tolerated profile 6.