Effect of Bromocriptine Treatment on Prolactin, Noradrenaline and Blood Pressure in Hypertensive Haemodialysis Patients

Abstract

Bromocriptine (2.5 mg/day orally) produced a significant fall in supine mean arterial pressure in nine hypertensive haemodialysis patients with high serum prolactin levels, without causing significant changes in heart rate. On bromocriptine, there was a significant decrease in the mean value of both serum prolactin and plasma noradrenaline, without significant changes in the mean value of plasma renin activity. A significant relationship was found between the changes in supine plasma noradrenaline and the changes in supine mean arterial pressure induced by bromocriptine. The increase in mean arterial pressure in response to the tilt test was greater on bromocriptine than on placebo although the changes in plasma noradrenaline were reduced by bromocriptine. Similar results were observed during the cold pressor test. These findings suggest that the arterial pressure-lowering effect of bromocriptine is related to the reduction in sympathetic out-flow. The parallel decrease in serum prolactin raises the question of the possible involvement of dopaminergic mechanisms in the development of hypertension in our patients. Moreover, bromocriptine seems to enhance the vascular response to endogenous noradrenaline.

Prolactin Levels, Endothelial Dysfunction, and the Risk of Cardiovascular Events and Mortality in Patients with CKD

“…However, it is unknown whether prolactin normalization improved any atherosclerotic/ cardiovascular-related outcomes. Intriguingly, some small studies have evaluated the effects of bromocriptine therapy in CKD patients on the basis of its dopamine D2 receptor agonist properties, reporting a reduction in BP and regression of left ventricular hypertrophy in dialysis patients (41)(42)(43). Whether this effect was mediated by prolactin reduction, at least partly, is unknown.…”

Circadian‐timed quick‐release bromocriptine lowers elevated resting heart rate in patients with type 2 diabetes mellitus

“…Bromocriptine‐QR (B‐QR), a quick‐release formulation of micronized bromocriptine, is the only sympatholytic dopamine‐agonist US FDA‐approved for the treatment of type 2 diabetes. In several preclinical and clinical studies, bromocriptine administration has repeatedly been demonstrated to reduce measures of elevated SNS activity such as reduction of elevated sympathetic outflow, plasma norepinephrine, BP and/or conversion of nondipper profile of circadian mean arterial pressure to a dipper profile. A critical aspect of dopaminergic control of autonomic function is via circadian modulation of the central biological clock pacemaker circuit (circadian neuronal afferent signals to and including the suprachiasmatic nuclei [SCN]) (see below).…”

Cardiovascular and Renal Effects of Bromocriptine in Diabetic Patients with Stage 4 Chronic Kidney Disease

“…Furthermore, PRL levels decreased significantly as compared with the PBO group, suggesting an improvement in the dopaminergic tone. A cardioprotective effect of BEC, expressed as a reduction in blood pressure, has been previously reported in hypertensive patients with end-stage renal disease (ESRD) on peritoneal dialysis or hemodialysis [17, 21–23]. More recent reports suggest that the elevated levels of NE and the sympathetic overactivity stimulate and promote cardiomyocyte hypertrophy and myocardial fibrosis resulting in increased LV mass [19, 20, 35].…”

“…Bromocriptine (BEC; bromoergocriptine), a type-2 dopamine receptor (D2) agonist, can reduce sympathetic activity and levels of circulating NE and thus contribute to the management of high blood pressure and LVH in patients with CKD. In previous studies, it has been demonstrated that the use of low doses of BEC permits adequate blood pressure control and reduces LV mass in both peritoneal dialysis and hemodialysis patients [21–23]. …”