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A dual approach to adaptive control of arterial blood pressure using sodium nitroprusside is presented. In the clinical environment, a controller must be aggressive to achieve specific step response characteristics (less than 10 min setting time, less than 10 mm Hg overshoot), yet conservative enough to prevent overreactions to large disturbances, which are common in both the operating room and the intensive care unit. These mutually exclusive requirements make it difficult to design a closed-loop controller for this environment. To prevent possible overreactions while maintaining proper step response, an aggressive adaptive controller has been designed to achieve the desired step response, and a supervisor has been designed around the adaptive controller to limit potential overreactions in the presence of disturbances. Simulations and dog experiments demonstrate the potential for increased safety and efficacy using this dual approach to the control of a complex physiological system.