#hypertensive_Retinopathy #Up_ToDate
The parenteral antihypertensive agents most often used in the initial treatment of moderate to severe hypertensive retinopathy and/or hypertensive encephalopathy are :
🔹Clevidipine – The initial dose is 1 mg/hour and the usual maximum dose is 21 mg/hour.
🔹Nicardipine – The initial dose is 5 mg/hour and the usual maximum dose is 15 mg/hour.
🔹Fenoldopam – given as an intravenous infusion. The initial dose is 0.1 mcg/kg per min and the dose is titrated at 15-minute intervals
🔹Sodium nitroprusside – given as an intravenous infusion. The initial dose is 0.25 to 0.5 mcg/kg per min and the usual maximum dose is 8 to 10 mcg/kg per min.
🔹Labetalol – given as an intravenous bolus or infusion. A 20 mg bolus is usually given initially, followed by 20 to 80 mg intravenously every 10 minutes to a total dose of 300 mg.
Labetalol can also be given as a continuous infusion at 0.5 to 2 mg/min.
⛔Labetalol should not be used without prior adequate alpha blockade in patients with hyperadrenergic states
#GOAL of therapy :
🔹The initial aim of treatment in patients with moderate to severe hypertensive retinopathy and/or hypertensive encephalopathy is to rapidly lower the mean arterial pressure by approximately 10 to 15 percent in the first hour, and by no more than 25 percent compared with baseline by the end of the first day of treatment ..
🔹This level of blood pressure (BP) control will allow gradual healing of the necrotizing vascular lesions. More aggressive hypotensive therapy is both unnecessary and may reduce BP below the autoregulatory range, possibly leading to ischemic events (such as stroke or myocardial infarction)
The parenteral antihypertensive agents most often used in the initial treatment of moderate to severe hypertensive retinopathy and/or hypertensive encephalopathy are :
🔹Clevidipine – The initial dose is 1 mg/hour and the usual maximum dose is 21 mg/hour.
🔹Nicardipine – The initial dose is 5 mg/hour and the usual maximum dose is 15 mg/hour.
🔹Fenoldopam – given as an intravenous infusion. The initial dose is 0.1 mcg/kg per min and the dose is titrated at 15-minute intervals
🔹Sodium nitroprusside – given as an intravenous infusion. The initial dose is 0.25 to 0.5 mcg/kg per min and the usual maximum dose is 8 to 10 mcg/kg per min.
🔹Labetalol – given as an intravenous bolus or infusion. A 20 mg bolus is usually given initially, followed by 20 to 80 mg intravenously every 10 minutes to a total dose of 300 mg.
Labetalol can also be given as a continuous infusion at 0.5 to 2 mg/min.
⛔Labetalol should not be used without prior adequate alpha blockade in patients with hyperadrenergic states
#GOAL of therapy :
🔹The initial aim of treatment in patients with moderate to severe hypertensive retinopathy and/or hypertensive encephalopathy is to rapidly lower the mean arterial pressure by approximately 10 to 15 percent in the first hour, and by no more than 25 percent compared with baseline by the end of the first day of treatment ..
🔹This level of blood pressure (BP) control will allow gradual healing of the necrotizing vascular lesions. More aggressive hypotensive therapy is both unnecessary and may reduce BP below the autoregulatory range, possibly leading to ischemic events (such as stroke or myocardial infarction)