vi medicine informatics




Drugs used in situations of hypertensive urgency preferentially vasodilate arteries and are short acting. Sodium nitroprusside (increases NO and cGMP) and fenoldopam (D1 agonist) are used preferentially followed by labetalol, nicardipine, and clevidipine. Dosages are tapered over the course of 24-48 hours until a target BP is reached. Immediate, rapid decreases in BP can result in hypoperfusion of the brain because of failure of autoregulation in the cerebral circulation. Long standing benign hypertension can cause hyaline arteriolosclerosis in which fibrin deposition thickens arterioles. Hypertensive crises can cause hyperplastic arteriolosclerosis in which smooth muscle cells in the tunica media rapidly enlarge, causing an onion skin appearance on histology.

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