Hydralazine (Apresoline)
Its use is best avoided in the management of hypertensive crises - Ashley and Brooke Barlow PharmDs
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Hydralazine is Broken (No Need to Fix It)
Hydralazine is much like rolling the dice on blood pressure management. You do not know when the blood pressure will change or what level to expect it to drop. Following its administration, hydralazine has a latent period ranging from five to 15 minutes before onset of action, and after onset it can cause an abrupt fall in blood pressure lasting up to 12 hours...
Perhaps the perception is that hydralazine is a benign medication and that one dose of hydralazine can't possibly be that harmful. Sadly, given its long half-life, adverse effects may not be recognized or connected to hydralazine if they occur hours later, prompting the clinician to make poor reactionary decisions.
Resources
Hypertensive Emergency: Pearls and Pitfalls for the ED Physician
Hydralazine and diuretics have limited value, and in-fact a potential for harm if used for hypertensive emergency. Hydralazine remains extensively used despite its suboptimal pharmacokinetics and the substantial, unpredictable antihypertensive response.2 After IV administration, there is an initial latency period of up to 15 minutes, followed by sporadic, progressive and often precipitous decline in BP.26 Furthermore, don’t let the half-life of 3 hours deceive you, as the pharmacologic response to hydralazine can persist for up to ~8-12 hours.27,28 Taken together, the unpredictable response and difficulty in titration, its use is best avoided in the management of hypertensive crises.
Retrospective review of the use of as-needed hydralazine and labetalol for the treatment of acute hypertension in hospitalized medicine patients
Several studies have demonstrated the inappropriate use of PRN intravenous (IV) hydralazine and labetalol for the management of severe blood pressure elevations in hospitalized patients.
Vasodilator Drugs: Chronic Vasodilator Therapy – Hydralazine
With the introduction of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and beta-adrenergic blockers, chronic vasodilator therapy has moved into a second- or third-level therapy for chronic heart failure. At the present time, chronic oral vasodilator therapy consists of hydralazine, a nitrate preparation, and a combination of these two groups.
Hydralazine is Broken (No Need to Fix It)
Hydralazine, a potent vasodilator, is used throughout the United States as an intravenous medication to lower blood pressure, and it is often used off-label for hypertensive emergencies though it has little evidence of improved outcomes. Many issues with hydralazine should raise eyebrows among emergency physicians.
Hydralazine (Apresoline)
Initiate therapy in gradually increasing dosages; adjust according to individual response. Start with 10 mg four times daily for the first 2 to 4 days, increase to 25 mg four times daily for the balance of the first week.
GoodRx
It is not a first-choice drug, but it can be helpful for people who have high blood pressure and other first-choice drugs are not working.
ScienceDirect
Hydralazine exerts a preferential effect on arterioles compared with veins. The resulting changes are decreased peripheral resistance; decreased blood pressure; and reflexively increased heart rate, stroke volume, and CO.
StatPearls
In current practice, oral hydralazine is used in essential hypertension refractory to other therapeutic agents. Studies comparing its effects as an add-on medication to multidrug treatment for hypertension have proved effective but not as efficacious as other multi-modal first-line therapies (calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, thiazides).
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