Intravenous fenoldopam versus sodium nitroprusside in patients with severe hypertension.

Abstract

In an open-label study, we compared the efficacy and safety of intravenous infusion of fenoldopam mesylate with that of sodium nitroprusside in patients with severe hypertension or in hypertensive crisis. Both antihypertensive medications were infused at a maximal dose increment of 0.2 microgram/kg/min (fenoldopam) and 1 microgram/kg/min (nitroprusside), with a maximal infusion rate of 1.5 micrograms/kg/min fenoldopam mesylate or 8 micrograms/kg/min sodium nitroprusside. Once the desired reduction in diastolic blood pressure was achieved (less than 110 mm Hg if initial diastolic blood pressure was 120-149 mm Hg, or by at least 40 mm Hg if initial diastolic blood pressure was 150-190 mm Hg), the maximal infusion rate used was maintained for at least 1 hour, and then, the infusion was slowed gradually over 2 hours. After the infusion treatment, patients remained in the hospital for 2 days of follow-up. Both antihypertensive agents successfully controlled the blood pressure in all the patients by the end of the maintenance periods. Between the baseline and the end of the maintenance period, analysis of variance showed that the changes in the variables induced by fenoldopam mesylate did not differ significantly from those induced by sodium nitroprusside. The incidence of side effects listed were similar in both groups of patients. The detection of toxic levels of thiocyanate in two patients treated with nitroprusside, however, shows that fenoldopam might be preferable for the control of a hypertensive crisis or severe hypertension in patients with decreased renal function.

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

“…[24][25][26][27][28][29][30][31][32][33][34][35] Other trials included patients without explicitly stating whether patients had acute end-organ damage or not (7 trials). [36][37][38][39][40][41][42] Some trials included non-randomized participants in the trial's results (1 trial). 43 One trial did not report any of the outcomes of interest (1 trial).…”

“…In 19 of the excluded trials [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] it was not possible to determine how many patients had acute endorgan damage or merely had elevation of blood pressure. We believe that it would be misleading to include these trials in this review as the impact of antihypertensive drugs is potentially different.…”

Potential Dopamine-1 Receptor Stimulation in Hypertension Management

“…Moreover, nitroprusside poses a concern about thiocyanate toxicity. In a single study of 9 patients, nitroprusside is reported to have increased plasma thiocyanate concentration in 2 patients, but there were no signs of toxicity [78].…”

“…Chronic administration of ecopipam increases blood pressure in humans [78]. Chronic D1-like receptor blockade in rodents also increases blood pressure [79].…”

Hypertensive Emergencies in the Emergency Department

“…It produces no toxic metabolites and has been shown to be as effective in blood pressure reduction as nitroprusside. 28,29 In the special case of scleroderma renal crisis, angiotensin-converting enzyme inhibitors (eg, captopril and enalapril) are first-line agents for effect management. 30 …”