GABARITO: ALTERNATIVA D

Explanation:

Hypertensive crisis

Hypertensive urgency

Severe hypertension (≥180/120 mm Hg)
No evidence of end-organ damage

Hypertensive emergency

Severe hypertension with end-organ damage:
- Cardiovascular: angina, myocardial infarction, aortic dissection
- CNS: encephalopathy, cerebral infarct/hemorrhage
- Kidney: acute hypertensive nephrosclerosis
- Lung: pulmonary edema
- Retina: papilledema, flame-shaped hemorrhages, exudates

This patient presents with severely elevated blood pressure and signs of end-organ damage, including confusion (suggestive of hypertensive encephalopathy), bilateral papilledema, and impaired renal function (elevated serum creatinine). These findings indicate a hypertensive emergency, which necessitates prompt yet controlled blood pressure reduction to prevent further damage. Intravenous antihypertensives are preferred in this setting for their rapid onset and ability to be titrated.

Fenoldopam is a short-acting, selective peripheral dopamine-1 receptor agonist. It stimulates adenylyl cyclase through Gs-protein activation, increasing intracellular cAMP. This leads to arteriolar vasodilation, with a marked effect on the renal vasculature, resulting in enhanced renal perfusion, increased urine output, and natriuresis. These properties make fenoldopam particularly valuable in hypertensive emergencies complicated by renal insufficiency.

Educational Objective:

Fenoldopam is a selective dopamine-1 receptor agonist that lowers blood pressure through systemic and renal vasodilation. It also enhances renal perfusion, urine output, and sodium excretion, making it especially useful in hypertensive emergencies accompanied by renal impairment.

Answer Choice Explanations: