Drug treatment

Drug therapy dependent on concomitant factors:

• if left ventricular failure then a loop diuretic and nifedipine 10-20 mg/8h.
• suspected phaeochromocytoma: labetalol 20-200 mg 24 hourly.
• if beta-blockers are contra-indicated then nifedipine 10-20 mg/8h. Blood pressure should fall gently after approximately 30 minutes.
• if beta-blockers not contra-indicated then atenolol 50-100 mg once daily.

If patient requires minute-by-minute control of blood pressure, for example during a seizure, then use sodium nitroprusside. Give 0.3-8 mcg / kg / min IVI in 5% dextrose, for example 50 mg nitroprusside in one litre of dextrose 5%. Should expect to give at 100-200 ml/h. Titrate the dose against regular blood pressure. Aim for a diastolic of 100-110 mmHg. To prevent photodeactivation cover the burette with reflective foil.