Hemodynamic profile of intravenous fenoldopam in patients with hypertensive crisis

Abstract

Fenoldopam, a newly developed intravenous dopaminergic DA1 receptor agonist, was used in an open, prospective study for blood pressure control in 12 patients presenting with hypertensive crisis. At a dose of 0.2-0.5 microgram kg-1 min-1 fenoldopam decreased systolic blood pressure from 209 +/- 13 to 151 +/- 17 mmHg and diastolic blood pressure from 114 +/- 10 to 78 +/- 10 mmHg. Blood pressure was controlled in all 12 patients within 5-50 min. In none of the patients did rebound hypertension occur upon termination of the study medication, nor was any adverse event reported. Major hemodynamic changes induced by fenoldopam were a decrease in total peripheral resistance from 1853 +/- 611 to 1193 +/- 368 and in pulmonary vascular resistance from 252 +/- 170 to 180 +/- 74 dyne s-1 cm-5. In patients with high left ventricular filling pressure at study pulmonary capillary wedge pressure decreased while the stroke volume index and mixed venous oxygen saturation increased under fenoldopam. Thus, fenoldopam appears to be a rapid-acting, well-tolerated, and highly effective intravenous substance for the treatment of severe hypertension.

Perioperative hypertension management

“…The onset of action of fenoldopam is within 5 minutes, with the maximal response being achieved by 15 minutes (Weber et al 1988; White et al 1988; Munger et al 1990; Bodmann et al 1993). The elimination half-life of fenoldopam is ~5 minutes (Bedford Laboratories 2004), with a duration of action from 30 to 60 minutes.…”

Perioperative hypertension: a review of current and emerging therapeutic agents,

“…Ten times more potent than dopamine, fenoldopam has the distinct advantage of mediating renal arterial vasodilation and activating dopamine receptors on the proximal and distal tubules, inhibiting sodium reabsorption and thereby promoting natriuresis and diuresis [84]. Onset of action is within 5 minutes, with a maximal response achieved within 15 minutes [85][86][87]. Duration of action is 30 to 60 minutes and does not cause rebound hypertension when the infusion is discontinued.…”

Management of Hypertensive Emergencies

“…Fenoldopam acts on peripheral dopamine-1 receptors resulting in peripheral vasodilatation, predominantly in the renal, cardiac and splanchnic vascular beds [22][23][24]. Ironically despite decreasing the blood pressure, it increases the renal perfusion [22][23][24].…”

“…Ironically despite decreasing the blood pressure, it increases the renal perfusion [22][23][24]. In several studies comparing fenoldopam to other anti hypertensive agents in hypertensive emergencies, improved creatinine clearance was observed [25][26][27].…”