A 62-year-old man presents with acute pulmonary edema and a blood pressure of 210/120 mmHg. He has no focal neurological deficits and no signs of myocardial ischemia. Which intravenous antihypertensive is most appropriate for immediate blood pressure control?

• A Sodium nitroprusside
• B Labetalol
• C Hydralazine
• D Nitroglycerin ✓

Explanation

In hypertensive emergency with acute pulmonary edema, intravenous nitroglycerin is preferred because it reduces preload and afterload, improves coronary blood flow, and relieves pulmonary congestion. Sodium nitroprusside can cause coronary steal and is reserved for when nitroglycerin fails. Labetalol may worsen acute heart failure. Hydralazine causes reflex tachycardia and is not ideal in this setting.

Reference: Harrison's Principles of Internal Medicine, 20th ed.

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Written and medically reviewed by the StethoPrep medical team.