A 50-year-old woman with diffuse cutaneous systemic sclerosis develops a blood pressure of 195/115 mm Hg, headache, and blurred vision. Laboratory tests reveal microangiopathic hemolytic anemia and a serum creatinine of 3.2 mg/dL. What is the most appropriate immediate treatment?

• A Sublingual nifedipine
• B Oral amlodipine
• C Intravenous labetalol
• D Intravenous captopril ✓

Explanation

Scleroderma renal crisis is a medical emergency treated with ACE inhibitors, which dramatically improve survival and renal outcome. Intravenous captopril is used for rapid blood pressure control. Calcium channel blockers and beta-blockers are less effective. Sublingual nifedipine can cause precipitous hypotension and is not recommended.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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