To the Editor: We read with concern the review article entitled “Treatment of Hypertensive Crisis,” by Calhoun and Oparil (Oct. 25 issue),1 wherein the authors advocate sodium nitroprusside as “the preferred agent” to lower blood pressure in patients with cerebral infarction or intracerebral hemorrhage. Because sodium nitroprusside increases venous capacitance, while also acting as a potent arterial vasodilator, it increases cerebral blood volume and may consequentially exacerbate intracrarnial hypertension.2 These effects have been verified experimentally,3 and although generally safe, the use of sodium nitroprusside has been discouraged in conditions in which intracranial pressure might be elevated4 — a frequent occurrence. © 1991, Massachusetts Medical Society. All rights reserved.
