Which antihypertensive drug reduces both preload and afterload, is the drug of choice in hypertensive emergency with acute LV failure, and acts primarily by releasing nitric oxide?
- A Hydralazine (arteriolar vasodilator)
- B Fenoldopam (selective dopamine D1 receptor agonist)
- C Clevidipine (ultra-short-acting dihydropyridine calcium channel blocker)
- D Sodium nitroprusside (balanced arteriovenous vasodilator via NO release) ✓
Explanation
Sodium nitroprusside spontaneously releases nitric oxide (NO) in both arterial and venous smooth muscle, causing balanced vasodilation that reduces both preload (venodilation) and afterload (arteriodilation), making it the drug of choice in hypertensive emergency complicated by acute left ventricular failure. Hydralazine is primarily an arteriolar dilator with minimal venous effect. Fenoldopam provides selective renal arteriolar dilation. Clevidipine is predominantly an arterial vasodilator. Nitroprusside requires IV infusion and monitoring for cyanide toxicity in prolonged use.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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