Hypertensive Encephalopathy Medication

Updated: Dec 10, 2018
  • Author: Irawan Susanto, MD, FACP; Chief Editor: Helmi L Lutsep, MD  more...
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Medication Summary

Pharmacologic agents selected for use in hypertensive encephalopathy should have few or no adverse effects on the central nervous system (CNS). Antihypertensive medications used in this setting include labetalol, nicardipine, esmolol, nitroprusside sodium, phentolamine, nitroglycerin, and hydralazine.


Antihypertensive, Other

Class Summary

Antihypertensive agents are used to reduce blood pressure.

Labetalol (Trandate)

Labetalol is a competitive and selective alpha1 blocker and a nonselective beta-blocker that has predominantly beta effects at low doses. The onset of action is 5 minutes, and the half-life is 5.5 hours. Labetalol produces a steady, consistent drop in blood pressure without compromising cerebral blood flow (CBF).

Nicardipine (Cardene)

Nicardipine is a calcium channel blocker that has a potent and rapid onset of action, is easy to titrate, and lacks toxic metabolites. It appears to be effective in hypertensive encephalopathy, but the reported experience is limited.

Esmolol (Brevibloc)

Esmolol is an ultrashort-acting agent that selectively blocks beta1 receptors but has little or no effect on beta2 receptor types. It is particularly useful in patients with elevated arterial pressure, especially if surgery is planned. Esmolol has been shown to reduce episodes of chest pain and clinical cardiac events in comparison with placebo. It can be discontinued abruptly if necessary.

Esmolol is useful in patients at risk for experiencing complications from beta blockade, particularly those with reactive airway disease, mild-to-moderate left ventricular dysfunction, or peripheral vascular disease. Its short half-life (8 minutes) allows easy titration to the desired effect and quick discontinuance if necessary.

Nitroprusside sodium (Nitropress)

Nitroprusside sodium decreases systemic vascular resistance by causing direct dilatation of arterioles and veins. It should be avoided in patients suspected of having increased ICP. It may cause intracerebral shunting of blood, thereby increasing ICP.

Phentolamine (Oraverse)

Phentolamine is an alpha1- and alpha2-adrenergic blocking agent that blocks circulating epinephrine and norepinephrine action, reducing the hypertension that results from catecholamine effects on the alpha-receptors.

Nitroglycerin (Nitro-Bid, Minitran, Nitro-Dur, Nitrostat)

Nitroglycerin provides arteriolar dilation and venodilation. It is used in emergencies involving myocardial ischemia because of its dilatory effects on coronary arteries.


Hydralazine is a direct arteriolar dilator. It plays a limited role in this setting because of reflex tachycardia causing increased cardiac oxygen demand. It should be avoided in patients suspected of having increased ICP.