Cardiology Corner: Hypertensive Emergencies Part 2

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Elizabeth D. -

Hello,

In this section, for treatment of hypertension in aortic dissection, I heard you recommend co-administration of beta blockers and calcium channel blockers. I thought this was a classic no-no. Can you explain this more?

Thank you!

Anand S., M.D. -

Great question and I think we've generalized too much in the past. Depends on agent.
Esmolol is a beat 1 antagonist which primarily works on the hear to reduce heart rate but has pretty minimal effects on the vasculature (ie doesn't cause much vasodilation)
Nicardipine is a dihydropyridine which vasodilates but has little effect on chronotropy.
Essentially, these are working at different locations and won't have much additive effect
Diltiazem and other non-dihydros, on the other hand have chronotropy effects. I would not use diltiazem along with a beta blocker that primarily works on chronotropy as well as the two in combo may cause profound issues with the heart rate. This really applies to using both IV.
Hope that clears it up a bit

Amal M., M.D. -

Yes, exactly as Swami said.
The general teaching is to avoid using two different classes of AV nodal blockers together, e.g. esmolol or metoprolol PLUS diltiazem or verapamil. However, nicardipine is primarily being used here for its afterload reducing effect, not for further AV nodal blockade.

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