Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension.

Elliott, W.J.; Weber, Roy R.; Nelson, K. S.; Oliner, C M; Fumo, Maryann T.; Gretler, Daniel D.; McCray, G.R.; Murphy, Michael B.

doi:10.1161/01.cir.81.3.970

Cited by 116 publications

(61 citation statements)

References 32 publications

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“…Fifteen RCTs (869 patients) were found that satisfied the inclusion criteria [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] ( Table 2). Two trials were placebo controlled.…”

Section: Resultsmentioning

confidence: 99%

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Perez

Musini

2008

J Hum Hypertens

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Hypertensive emergencies occur when high blood pressure is associated with the presence of acute endorgan damage, such as hypertensive encephalopathy. There is controversy as to when and which antihypertensive drugs to use in these situations. Using a comprehensive search strategy in electronic sources, MEDLINE, EMBASE and Cochrane clinical trial register, we conducted a systematic review to look all randomized control trials (RCTs) that compare an antihypertensive drug versus placebo, no treatment or another antihypertensive drug. Fifteen RCTs (representing 869 patients) met the inclusion criteria. Two trials included a placebo arm. All studies (except one) were open-label trials. Seven drug classes were evaluated in those trials: nitrates (nine trials), angiotensin-converting enzyme inhibitors (seven), diuretics (three), calcium channel blockers (six), a-1 adrenergic antagonists (four), direct vasodilators (two) and dopamine agonists (one). Mortality event data were reported in seven trials. Due to insufficient data, no meta-analysis was performed for clinical outcomes. Differences in blood pressure changes between antihypertensives were minor. There is no RCT evidence demonstrating that antihypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies. Furthermore, there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity. There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another. However, the clinical significance is unknown. RCTs are needed to assess different drug classes to determine initial and longer-term mortality and morbidity outcomes.

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“…Fifteen RCTs (869 patients) were found that satisfied the inclusion criteria [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] ( Table 2). Two trials were placebo controlled.…”

Section: Resultsmentioning

confidence: 99%

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Perez

Musini

2008

J Hum Hypertens

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“…106 A comparative study of fenoldopam with nitroprusside in patients with hypertensive crisis revealed that while both of these compounds caused a prompt lowering of blood pressure, the additional beneficial effect seen with fenoldopam was that it promoted natriuresis and diuresis in these patients. 107 Because RBF was not measured in this study, it is not clear whether natriuretic response was secondary due to an increase in RBF or whether it resulted from the direct tubular action of fenoldopam on D 1 -like dopamine receptors. It is reported that activation of D 1 -like receptors located on the juxtaglomerular cells causes an increase in renin release, 63 and we have shown in animal experiments that the natriuretic and diuretic effect of fenoldopam is markedly potentiated by pretreatment with angiotensin-converting enzyme inhibitors and losartan.…”

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confidence: 91%

Renal Dopamine Receptor Function in Hypertension

1998

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Abstract-Dopamine plays an important role in the regulation of renal sodium excretion. The synthesis of dopamine and the presence of dopamine receptor subtypes (D 1A , D 1B as D 1 -like and D 2 , and D 3 as D 2 -like) have been shown within the kidney. The activation of D 1 -like receptors located on the proximal tubules causes inhibition of tubular sodium reabsorption by inhibiting Na,H-exchanger and Na,K-ATPase activity. The D 1 -like receptors are linked to the multiple cellular signaling systems (namely, adenylyl cyclase, phospholipase C, and phospholipase A 2 ) in the different regions of the nephron. Defective renal dopamine production and/or dopamine receptor function have been reported in human primary hypertension as well as in genetic models of animal hypertension. There may be a primary defect in D 1 -like receptors and an altered signaling system in the proximal tubules that lead to reduced dopamine-mediated effects on renal sodium excretion in hypertension. Recently, it has been shown in animal models that the disruption of either D 1A or D 3 receptors at the gene level causes hypertension in mice. Dopamine and dopamine receptor agonists also provide therapeutic potential in treatment of various cardiovascular pathological conditions, including hypertension. However, because of the poor bioavailability of the currently available compounds, the use of D 1 -like agonists is limited to the management of patients with severe hypertension when a rapid reduction of blood pressure is clinically indicated and in acute management of patients with heart failure. In conclusion, there is convincing evidence that dopamine and dopamine receptors play an important role in regulation of renal function, suggesting that a defective dopamine receptor/signaling system may contribute to the development and maintenance of hypertension. Further studies need to be directed toward establishing a direct correlation between defective dopamine receptor gene in the kidney and development of hypertension. Subsequently, it may be possible to use a therapeutic approach to correct the defect in dopamine receptor gene causing the hypertension. (Hypertension. 1998;32:187-197.)Key Words: dopamine Ⅲ receptors, dopamine Ⅲ kidney tubules, proximal Ⅲ kidney Ⅲ hypertension, renal D opamine is known to play an important role in the control of renal sodium excretion. Specific receptors for dopamine have been identified in various regions of the nephron, and it is reported that dopamine is synthesized within the renal proximal tubules. Endogenously produced dopamine, as well as exogenously administered dopamine, exerts pronounced effects on renal function. There are reports suggesting that a defect in renal dopamine receptor function and/or dopamine production may play a role in the pathogenesis of hypertension. For example, reduced urinary dopamine/ sodium excretion is reported in some forms of human primary hypertension. [1][2][3] It is reported that a defect in dopamine receptor-G protein coupling and alterations in the signaling component...

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“…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]. Therefore, this could be a useful drug in patients with hypertensive emergencies associated with acute renal failure.…”

Section: Fenoldopammentioning

confidence: 99%

“…Nitroprusside is often used; however it has increased risk of cyanide toxicity in patients with renal failure. Fenoldopam-the dopamine 1 agonist, has been shown to improve natriuresis, diuresis and creatinine clearance compared to nitroprusside in a few studies and is currently preferred over nitroprusside in patients with renal failure [25][26][27].…”

Section: Acute Kidney Injurymentioning

confidence: 99%

Management of Hypertensive Emergencies

Penumetsa¹

2013

J Hypertens

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Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension.

Cited by 116 publications

References 32 publications

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Renal Dopamine Receptor Function in Hypertension

Management of Hypertensive Emergencies

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