A hypertensive patient stops taking clonidine abruptly. Three days later he presents with blood pressure 220/130 mmHg, agitation, sweating, and palpitations. The most appropriate immediate management is:
- A Intravenous propranolol alone
- B Reinstitution of clonidine or intravenous labetalol ✓
- C Sublingual nifedipine and discharge home
- D Intravenous sodium nitroprusside followed by lifelong minoxidil
Correct answer: B. Reinstitution of clonidine or intravenous labetalol
Explanation
Abrupt cessation of clonidine causes rebound hypertension due to loss of central alpha-2 mediated suppression of sympathetic outflow, with catecholamine levels exceeding baseline. Treatment is resumption of clonidine, or an agent with combined alpha and beta blockade such as labetalol. Propranolol alone is dangerous because unopposed alpha-mediated vasoconstriction can worsen the crisis. Sodium nitroprusside is reserved for refractory cases, and minoxidil has no role in this acute setting.
Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.