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An estimated 30% of adults in the United States have hypertension; thus, antihypertensives are medications commonly found in patient homes.1 Several classes of drugs used to treat hypertension are discussed in this chapter: diuretics, sympatholytic agents, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and vasodilators (Table 196-1). Calcium channel blockers and β-blockers, also used in the treatment of hypertension, are discussed elsewhere (see chapters 195, "Calcium Channel Blockers," and 194, "Beta-Blockers").
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For most of these agents, life-threatening toxicity is not expected in acute overdose.2 In nearly all cases, good supportive care is adequate. The initial approach to the patient with potential overdose of an antihypertensive drug is fairly uniform. Secure the airway as necessary, establish IV access, provide continuous cardiac monitoring, and obtain an ECG. A bolus of crystalloid solution is first-line treatment for hypotension. If a vasopressor is required, a direct-acting drug such ...