279.2 🩺 國考版

279.2.1 高頻考點

279.2.1.1 Emergency vs Urgency

• Emergency: end-organ damage (encephalopathy, stroke, MI, edema, dissection, AKI, eclampsia)
• Urgency: no end-organ damage
• ICU + IV vs outpatient + oral

279.2.1.2 IV Agent Choice by Condition

Condition	First Choice	Avoid
Encephalopathy / PRES	Labetalol, nicardipine	Nitroprusside (CN+)
AIS (lysis candidate)	Labetalol, nicardipine; target < 185/110	Hydralazine
ICH	Nicardipine, target < 140 in 6h	Hydralazine (BP spikes)
ACS / pulmonary edema	NTG + β-blocker	Hydralazine (reflex tachy)
Aortic dissection	Esmolol first → nicardipine, target < 120 + HR < 60	Vasodilator alone
Eclampsia	Labetalol / hydralazine / nifedipine + Mg	ACEi/ARB
Pheo crisis	Phentolamine, nicardipine	β-blocker alone
Cocaine HTN	BZD + nicardipine + phentolamine	Pure β-blocker
AKI	Fenoldopam, nicardipine	Nitroprusside long-term (CN+)

279.2.1.3 Key Trials

• INTERACT-2 (2013): ICH SBP < 140 within 1h ↓ disability
• ATACH-II (2016): confirmed < 140 in ICH, no excess AKI in moderate
• CHASE (2024): chronic HTN management post-stroke
• NORMOTENSION trial: post-thrombectomy stricter BP control

279.2.2 易混淆比較

Term	BP	End-Organ Damage	Management
Severe asymptomatic HTN	> 180/120	No	Oral, F/U
Urgency	> 180/120	No	Oral, 24-48h reduce
Emergency	> 180/120	Yes	ICU + IV
Malignant HTN	Severe	Retinopathy III/IV + MAHA	ICU + IV

279.2.2.1 Pharmacology Pearls

• Esmolol: half-life 9 min → easy titration
• Clevidipine: ultra-short DHP, t½ 1 min
• Nicardipine: easier titration than nitroprusside
• Labetalol: α + β block
• Nitroprusside: cyanide risk with prolonged or high-dose use, AKI
• Hydralazine: unpredictable, reflex tachy

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