American Board of Internal Medicine (ABIM) Certification Practice Exam

What agent is suggested to lower blood pressure in cases of hypertensive intracerebral hemorrhage?

1. Enalapril

2. Amlodipine

3. Nicardipine

4. Lisinopril

The correct answer is: Nicardipine

In cases of hypertensive intracerebral hemorrhage, the goal is to manage blood pressure effectively to minimize further hemorrhagic complications and improve patient outcomes. Nicardipine, a calcium channel blocker, is often preferred in this context due to its properties that allow for rapid and effective control of blood pressure, particularly in an acute setting. Nicardipine provides convenient titratability and continuous intravenous infusion, which can be crucial in a critical care situation where precise blood pressure management is essential. This agent helps to achieve a targeted blood pressure reduction quickly without causing excessive hypotension, which can pose additional risks for patients experiencing a hemorrhagic stroke. In contrast, other agents listed, such as enalapril, amlodipine, and lisinopril, are typically used for chronic hypertension management. These medications may not be suitable for acute emergency situations like hypertensive intracerebral hemorrhage due to their longer onset of action or less predictable response when rapid intervention is necessary. Therefore, nicardipine's characteristics make it the most appropriate choice for lowering blood pressure in this specific clinical scenario.