In hypertensive emergency with pulmonary edema, which agent is particularly effective for rapid blood pressure control?

• A. Enalaprilat
• B. Nitroprusside
• C. Hydralazine
• D. Lisinopril

Answer: (B)

In a hypertensive emergency with pulmonary edema, you need an agent that can quickly lower blood pressure and reduce left-sided filling pressures to relieve the edema. Intravenous nitroprusside fits this need best because it is a potent balanced vasodilator that works on both arteries and veins. By dilating the arteries, it lowers afterload; by dilating the veins, it decreases venous return (preload). This dual action rapidly decreases left ventricular pressures and pulmonary capillary pressures, which helps to quickly reduce pulmonary edema and improve oxygenation. Its onset is immediate and its duration is short, allowing precise titration under close hemodynamic monitoring.

Other options don’t offer the same rapid, controllable effect. An IV ACE inhibitor like enalaprilat has a slower onset and isn’t ideal for urgent BP reduction. Hydralazine is an arterial vasodilator with more variable responses and can trigger reflex tachycardia, potentially complicating pulmonary edema. Lisinopril is an oral ACE inhibitor, not suitable for emergent blood pressure control.