The majority of direct acting vasodilating agents (i.e. hydralazine, sodium nitroprusside, nitroglycerin, and calcium channel blockers) cause an increase in cerebral blood volume. This can potentially cause an increase in ICP and CBF although the latter is dependent on systemic arterial pressure and the patient’s auto-regulation curve. Enalapril is unique in that it does not cause cerebral vasodilation and therefore no increase in cerebral blood volume.
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