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4. Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function

Author

Shusterman, Neil H., Elliott, William J., and White, William B.

Subjects
Dopamine -- Agonists, Sodium nitroferricyanide -- Physiological aspects, Antihypertensive drugs -- Evaluation, Hypertension -- Drug therapy, Chronic kidney failure -- Drug therapy, Health, Health care industry
Abstract

Purpose: Patients with hypertensive crises often experience reduced renal function that may worsen as the elevated blood pressure is treated. Fenoldopam, a novel, peripherally acting dopamine-1 agonist, lowers blood pressure through arteriolar vasolidation, with particularly prominent effects on the renal vascular bed. This study was conducted to examine the effects of fenoldopam on blood pressure and renal function compared to those of sodium nitroprusside in severely hypertensive patients with impaired renal function. Patients and methods: Renal function and systemic hemodynamics were studied in 19 severely hypertensive patients (diastolic blood pressure greater than or equal to 120 mm Hg) with impaired renal function (creatinine clearance less than or equal to 70 mL/min) enrolled in clinical trials of fenoldopam and sodium nitroprusside. For comparison, an additional 22 severely hypertensive patients with nonimpaired renal function were studied under the same conditions. Blood pressure and heart rate were measured at baseline before treatment and periodically during treatment. Renal function was determined before and during drug infusion by collection of timed urine specimens and blood samples. Creatinine clearance, urine flow rate, and sodium and potassium excretions were measured and compared. Results: In patients with impaired renal function, blood pressure (mean [+ or -] SEM) was reduced success in both groups (fenoldopam: 214 [+ or -] 8/139 [+ or -] 6 mm Hg to 176 [+ or -] 8/107 [+ or -] 3 mm Hg, p

Published
1993

5. Safety and efficacy of eprosartan, a new angiotensin II receptor blocker

Author

Shusterman, Neil H.

Subjects
Enzymes, Enzyme inhibitors, Hypertension, Peptide hormones, Cardiac patients, Angiotensin, Health
Abstract

Byline: Neil H. Shusterman Abstract: Angiotensin-converting enzyme inhibitors have been used extensively in the management of hypertension and related cardiovascular conditions. However, this treatment approach is limited by lack of specificity and continued production of angiotensin II by other routes. Antagonism of the angiotensin II receptor offers the possibility of improved control of hypertension by providing a more complete blockade of the renin-angiotensin system than angiotensin-converting enzyme inhibition without bradykinin-related effects. Eprosartan is the only nonbiphenyl, nontetrazole competitive angiotensin II receptor antagonist clinically available and is highly selective for the AT1 receptor subtype. In clinical trials, eprosartan has been shown to lower blood pressure effectively in a once-daily regimen in hypertensive patients. In the recommended dose range of 600 to 1200 mg once daily, eprosartan is effective in patients with all grades of hypertension irrespective of age, sex, or race. Furthermore, the tolerability profile of eprosartan is comparable to that of placebo, and there are no known clinically relevant drug-drug interactions. A number of large-scale clinical studies are currently underway or planned to determine which of the increasing number of AT1 receptor antagonists may reduce cardiovascular morbidity and mortality rates in different groups of hypertensive patients. Meanwhile, current evidence suggests that the AT1 receptor antagonists represent a significant new approach to cardiovascular therapy and merit a fuller assessment in hypertension and other cardiovascular diseases. (Am Heart J 1999;S238-S245.) Article Note: (footnote) [star] From SmithKline Beecham Pharmaceuticals., [star][star] Reprint requests: Neil H. Shusterman, MD, SmithKline Beecham Pharmaceuticals, 1250 S. Collegeville Rd, Collegeville, PA 19426. E-mail: Neil_H_Shusterman@sbphrd.com, a 0002-8703/99/$8.00 + 0 4/0/100206

Published
1999

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