Role of isradipine and other antihypertensive agents in the treatment of peri– and postoperative hypertension

The traditional therapy of perioperative hypertension is now being challenged by the availability of new agents. Vasodilator therapy should be the first-line choice, although dihydropyridine calcium antagonists, particularly isradipine, appear to be suitable in this setting because of their pharmacological properties. Because of its ultrashort half-life, sodium nitroprusside has to be administered by continuous infusion, even for the treatment of an acute elevation of blood pressure. This is not the case with the new agents that have longer durations of action. A bolus administration is sufficient for the correction of most elevations of arterial pressure that are due to transient adrenergic activation. Continuous infusion is required only in patients who have sustained increases of systemic vascular resistance; these are usually patients who are already hypertensive.