Once-a-day triple therapy with low-dose minoxidil for moderate hypertension

Minoxidil was given to 16 men with hypertension of various degrees of severity, in conjunction with a diuretic and atenolol. Mean supine and standing blood pressures (BP) on diuretic + atenolol were 172/106 and 162/104 mm Hg, respectively. Minoxidil was added and the dose titrated to lower the diastolic pressure to less than 90 mm Hg. All drugs were taken together once daily. At the end of a maintenance period of 6 months on an average dose of minoxidil of 12 mg (range 2.5 to 20.0 mg), supine BP was 147/87 and standing BP 139/88 mm Hg. Similar BP had been measured throughout the maintenance period, and monitoring of the BP showed that the once daily regimen provided good control for 24 h. A strong correlation was found between the dose of minoxidil necessary to normalize the BP and the mean arterial pressure prior to minoxidil (r = 0.73, P less than 0.005). Serious adverse effects of the drug were observed only in patients receiving doses greater than 10 mg or those with widespread atherosclerosis, or both. We conclude that, when added to a diuretic and a beta-blocker in a once-a-day regimen, minoxidil in a daily dose of less than or equal to 10 mg is effective and well tolerated in mild to moderate hypertension, especially in patients who are free of atherosclerotic complications.