Which agent is the best choice for intraoperative control of hypertension in an elderly male patient?

Intraoperative control of hypertension, particularly in elderly patients, requires careful consideration of the pharmacological properties of each agent. The correct choice is hydralazine, which is a potent vasodilator. It works by directly relaxing the vascular smooth muscle, leading to decreased systemic vascular resistance and a subsequent reduction in blood pressure.

Hydralazine is advantageous in the intraoperative setting due to its rapid onset and relatively short duration of action, allowing for easier titration to achieve the desired blood pressure control. Additionally, it does not negatively affect heart rate or cardiac output significantly, which is particularly important in elderly patients who may have cardiovascular comorbidities.

Other agents in the list may have specific applications or advantages, but hydralazine is preferred for its targeted action on blood vessels, making it effective in rapidly managing hypertension during surgery. Opioids, while often used for pain control, do not specifically address hypertension and can sometimes lead to hemodynamic instability. Labetalol and propranolol are both beta-blockers; while labetalol can also lower blood pressure, it may cause adverse effects in some elderly patients, particularly those with respiratory issues or bradycardia. Propranolol is typically used for arrhythmias or anxiety but