Dunbar L, Gregg K, Muniz A, Fellmann J, McGuire D, Luther R
Emergency department management of hypertensive emergencies: A
comparison of fenoldopam mesylate (Corlopam) versus sodium
nitroprusside
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:91A 1997
The treatment of hypertensive emergencies is somewhat
controversial due to the variety and complexity of the presenting
patients, the definitions of terms, as well as to the choice of
effective agents. The guiding principle since the days of diazoxide
IV push has been primum non nocere (do no harm). A new parenteral
agent,
fenoldopam, is under development for treatment of hypertensive
emergencies. This drug is a selective dopamine DA1 agonist.
The study appears to be a retrospective, non-randomized review
comparing hypertensive ER patients treated with fenoldopam compared
with nitroprusside. There were 16 paients in each group, with comparable
diastolic BPs (136.9 vs. 132.7 mmHg). Efficacy of both agents was
equivalent, but the fenoldopam group showed a "lower" incidence of
tachycardia and ischemic EKG changes (data not given). Fenoldopam was
described as "easier to use".
Comment: This study is limited by what appears to be a retrospective,
non-randomized design; there is lack of comparison of the groups as to age,
gender, renal function, etiology of hypertensive crisis, target organ
signs and symptoms. Outcome data are either not quantified
(tachycardia, EKG change incidence) or subjective (ease of use). A
larger (183 patient), prospective randomized trial comparing these
agents was reported in Academic Emergency Medicine by
Panacek et al 2:959, Nov 1995,
and showed equivalence of efficacy and side effects. The issue of ease
of use (i.e. need or lack thereof of invasive BP monitoring) merits
further study and may prove to be significant.
(James A. Sondheimer MD, Wayne State University, Detroit, MI)
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12th Annual ASH Meeting
H: Drug therapy :
Acute hypertensive crisis