Answer 32

32.  Choice A is the correct answer.  Labetolol and Vasotec are considered first line in the management of hypertensive emergency (malignant) hypertension.  Hctz will be not enough to lower this patients blood pressure.  The mean arterial pressure should not be lowered more than 25% in the first hour.  If it is lowered faster than that the patient is at risk for a watershed stroke.  Mannitol is only appropriate in certain situations to lower intracranial pressure.  Clonidine would help lower BP but would not give the steady control needed in this situation.  There is frequently rebound hypertension associated with clonidine.