Fenoldopam, a dopamine agonist, for hypertensive emergency: a multicenter randomized trial. Fenoldopam Study Group.

Academic Article

Abstract

  • UNLABELLED: Despite successful therapies for chronic hypertension, hospital admissions for hypertensive emergency more than tripled between 1983 and 1992. OBJECTIVE: To examine the safety and efficacy of fenoldopam, the first antihypertensive with selective and specific action on vascular dopamine (DA1) receptors, in a clinical trial involving emergency department patients with true hypertensive emergencies. METHODS: Patients with a sustained diastolic blood pressure (DBP) of > or =120 mm Hg and evidence of target organ compromise were randomized in a double-blinded manner to one of four fixed doses of intravenous fenoldopam (0.01, 0.03, 0.1, or 0.3 microg/kg/min) for 24 hours. The primary endpoint was the magnitude of DBP reduction in each of the three higher-dose groups after four hours of fenoldopam treatment compared with the lowest-dose group. RESULTS: One hundred seven participants from 21 centers were enrolled, and 94 patients received fenoldopam. Evidence of acute target-organ damage included new renal dysfunction or hematuria (50%), acute congestive heart failure or myocardial ischemia (48%), and papilledema or grade III-IV hypertensive retinopathy (34%). The DBP decreased in a dose-dependent fashion, with significant differences between the 0.1- and 0.3-microg/kg/min groups compared with the lowest-dose group. Treatment was well tolerated, and there were no deaths or serious adverse events during follow-up, up to 48 hours. All patients were successfully transitioned to oral or transdermal antihypertensives with maintenance of blood pressure control. CONCLUSIONS: Fenoldopam safely and effectively lowers blood pressure in a dose-dependent manner in patients with hypertensive emergencies. Observations supporting potential risk factors for hypertensive emergency are discussed.

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    Keywords

  • Adult, Aged, Analysis of Variance, Dopamine Agonists, Dose-Response Relationship, Drug, Double-Blind Method, Drug Administration Schedule, Emergency Treatment, Female, Fenoldopam, Follow-Up Studies, Humans, Hypertension, Malignant, Infusions, Intravenous, Male, Middle Aged, Probability, Prospective Studies, Reference Values, Severity of Illness Index, Treatment Outcome

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    Author List

  • Tumlin JA; Dunbar LM; Oparil S; Buckalew V; Ram CV; Mathur V; Ellis D; McGuire D; Fellmann J; Luther RR

    • Start Page

  • 653

    • End Page

  • 662

    • Volume

  • 7

    • Issue

  • 6