Which drug is used to treat hypertensive episodes?

• A. Atenolol
• B. Nifedipine
• C. Lisinopril
• D. Hydralazine

Answer: (D)

In a hypertensive episode, the goal is rapid reduction of blood pressure by directly dilating the resistance vessels. Hydralazine works best here because it directly relaxes the smooth muscle of arterioles, lowering systemic vascular resistance and quickly reducing blood pressure. When given promptly (often IV in emergencies), its onset is fast and the effect helps relieve the afterload on the heart.

Atenolol lowers blood pressure mainly by reducing heart rate and contractility, which works more gradually and isn’t the fastest option for an acute spike. Lisinopril lowers BP by inhibiting angiotensin II production, but the onset is slower and not ideal for immediate control. Nifedipine, a calcium channel blocker, can reduce BP as well, but short-acting forms carry risks of unpredictable drops and tachycardia in a hypertensive emergency, making it less suitable for urgent management.