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December 1989

Immediate Treatment of Severe Hypertension

Author Affiliations

Hypertension Center (W130) Veterans Administration Medical Center 5901 E Seventh St Long Beach, CA 90822

Arch Intern Med. 1989;149(12):2635-2637. doi:10.1001/archinte.1989.00390120007001

Most of the early observations in hypertension focused on severe forms of this condition, especially once the poor prognosis of malignant hypertension became apparent.1,2 Because physicians were then less rigorous in searching for hypertension routinely, patients quite frequently experienced the syndrome of malignant hypertension as their first clinical manifestation of hypertension.

In patients presenting with encephalopathy or other evidence for impending cerebrovascular or cardiovascular events, there was an obvious indication for rapid and vigorous intervention. Patients traditionally were treated with bed rest and by a variety of parenteral antihypertensive agents. Such agents as hydralazine, methyldopa, and reserpine eventually fell out of favor for hypertensive emergencies, for the onset and duration of their actions were unpredictable. Diazoxide exhibited more consistent effects, but excessive hypotensive responses sometimes were associated with its intravenous bolus administration. Thus, continuous infusion of nitroprusside has emerged as a treatment of choice: it works rapidly, and its

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