Q: 53 year old male with ESRD (Renal failure) is in ICU. Nurse ask you to write some prn medicine for BP control. Patient is already on high dose B-blocker. You write for IV Hydralazine. one hour after administration of Hydralazine you have been asked to evaluate patient for mental status change?



Answer: In patients particularly with renal failure/uremia hydralazine may produce a marked decrease in blood pressure, resulting in central reactions such as anxiety, delirium, disorientation, depression, and coma.

Also Hydralazine is a cerebral vasodilator and is known to increase intracranial pressure which, together with its effect upon systemic blood pressure, reduces the cerebral perfusion pressure.