Cardiovascular
Antihypertensives in the ICU
Severe acute hypertension in the ICU: end-organ consequences, antihypertensive mechanisms, and special considerations for TBI and post-cardiac surgery patients.
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- Severe acute hypertension:* SBP > 180 mmHg and/or DBP > 110 mmHg
End-organ damage from severe hypertension: heart failure, stroke/TIA, encephalopathy, aortic dissection, AKI.
Special ICU Considerations
Severe TBI: Blood pressure must maintain adequate CPP — aggressive lowering can worsen cerebral ischemia • Post-cardiac surgery:...Section
Special ICU Considerations
Severe TBI: Blood pressure must maintain adequate CPP — aggressive lowering can worsen cerebral ischemia • Post-cardiac surgery:...- Severe TBI: Blood pressure must maintain adequate CPP — aggressive lowering can worsen cerebral ischemia
- Post-cardiac surgery: Myocardium is more vulnerable after bypass — careful titration required
Antihypertensive Mechanisms
Class • Mechanism • ExamplesSection
Antihypertensive Mechanisms
Class • Mechanism • Examples| Class | Mechanism | Examples |
|---|---|---|
| Beta-blockers | Block beta-1; decrease HR and contractility | Metoprolol, esmolol |
| Centrally acting | Suppress sympathetic outflow from brain | Clonidine |
| Calcium channel blockers | Inhibit calcium in vascular smooth muscle → vasodilation | Nicardipine |
| Direct vasodilators | Directly relax vascular smooth muscle | Hydralazine |
| Alpha-blockade | Block alpha-1 → prevent vasoconstriction | Phentolamine |
| ACE inhibitors | Reduce angiotensin II → vasodilation | Enalaprilat |
| Loop diuretics | Reduce intravascular volume | Furosemide |
| Thiazide diuretics | Inhibit Na⁺ in distal tubule | Hydrochlorothiazide |
- Adapted from SurgCritCare. org for structured display and mobile use. Verify against current institutional policies and attending guidance.*