In a hypertensive patient (DBP >100 mmHg), which medication should be given?

• A. Norepinephrine infusion
• B. Nitroglycerin 1.6 mg SL; may repeat q5min for diastolic BP >100 mmHg
• C. Nitroglycerin 0.4 mg SL
• D. Labetalol IV

Answer: (B)

Rapid reduction of blood pressure in a hypertensive crisis with a diastolic pressure over 100 benefits from a fast-acting vasodilator that also alleviates myocardial workload. Sublingual nitroglycerin fits this need because it quickly dilates veins, lowering preload and reducing myocardial oxygen demand. In this protocol, a relatively higher sublingual nitroglycerin dose is given (1.6 mg) with the option to repeat every five minutes if the diastolic BP remains above 100. This approach provides rapid, incremental BP control while allowing ongoing reassessment after each dose.

As you administer, monitor for dizziness or hypotension, and ensure no recent use of PDE-5 inhibitors, which can interact dangerously with nitrates. Norepinephrine would raise blood pressure, making it unsuitable here. A standard small SL nitroglycerin dose (0.4 mg) might not achieve the desired BP reduction in this scenario, and intravenous options like labetalol require IV access and are typically reserved for settings with more monitoring and controls.