Before cardiac catheterization, what is the best initial therapy for a patient with ST-segment elevation myocardial infarction and severely elevated blood pressure?

The initial therapy for a patient experiencing ST-segment elevation myocardial infarction (STEMI) with severely elevated blood pressure focuses on reducing myocardial oxygen demand and alleviating the effects of elevated blood pressure while preparing for cardiac catheterization. Nitroglycerin is particularly effective in this scenario due to its dual action of providing vasodilation, which reduces both preload and afterload.

The use of nitroglycerin as an infusion helps to decrease myocardial oxygen consumption by lowering cardiac workload. In the context of STEMI, rapid relief of hypertension is crucial to improve coronary blood flow and minimize the area of myocardial ischemia. Additionally, nitroglycerin can help alleviate chest pain and improve comfort for the patient, which is essential in the acute setting.

While other agents such as nitroprusside or nicardipine can also lower blood pressure, they may not be the best initial choices due to the potential for more profound drops in blood pressure and the risk of rebound hypertension when discontinued. Nitroprusside requires close monitoring because it can lead to further complications, whereas nicardipine is more often used as a longer-term agent for hypertension management.

In summary, nitroglycerin is the preferred choice to initially manage severely elevated blood pressure in