Fenoldopam, a Dopamine Agonist, for Hypertensive Emergency: A Multicenter Randomized Trial

作者：James Alan Tumlin, Lala M. Dunbar, Suzanne Oparil, Vardaman M. Buckalew, C. Venkata S. Ram, Vandana S. Mathur, David J Ellis, Dawn McGuire, J. D. FELLMANN, Robert R. Luther, The Fenoldopam Study Group · 发表于：Academic Emergency Medicine · 年份：2000 · DOI：10.1111/j.1553-2712.2000.tb02039.x · 被引用次数：83 · 研究领域：Blood Pressure and Hypertension Studies、Heart Failure Treatment and Management、Acute Kidney Injury Research

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...