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Renal function in long-term minoxidil-treated patients
Abstract:
Renal function was monitored in 20 previously refractory hypertensive patients treated for 2--7 years with minoxidil, sympathetic suppressants, and diuretics. Serum creatinine concentration increased by more than 1 mg/dl in 9 of the 20 patients. In 4 of the 9 patients, renal disease progressed to require hemodialysis. Eleven patients had no progression of renal disease (creatinine increased less than or equal to 1 mg/dl). Three of the 11 had had malignant hypertension with renal failure which was reversed during this triple therapy. Neither the quality of blood pressure control nor the duration of minoxidil therapy correlated with increases in serum creatinine concentration. Plasma norepinephrine levels were higher (p less than 0.01) and plasma renin activity lower (p less than 0.02) in the group with progression of renal disease. Serum creatinine at the time when neuroendocrine studies were done correlated with PNE (r = 0.51, p less than 0.05). Addition of clonidine to this triple regimen in 2 patients with advanced renal disease lowered plasma norepinephrine by 63 and 81%. These findings suggest that the high norepinephrine levels are due to excess release of norepinephrine rather than defective renal elimination of this catecholamine. Whether the elevated plasma norepinephrine contributes to or is a result of the underlying disease is not known.
Insights
Minoxidil treatment for refractory hypertension can lead to worsening kidney function in some patients, indicated by increased serum creatinine. Elevated norepinephrine levels may play a role in this renal disease progression.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Refractory hypertension poses significant challenges in patient management.
- Minoxidil, in combination with sympathetic suppressants and diuretics, is used for severe hypertension.
- The long-term effects of this regimen on renal function require further investigation.
Purpose of the Study:
- To assess the impact of long-term minoxidil, sympathetic suppressants, and diuretics on renal function in hypertensive patients.
- To investigate the relationship between neuroendocrine factors and renal disease progression in this patient cohort.
Main Methods:
- Longitudinal monitoring of renal function (serum creatinine) in 20 patients over 2-7 years.
- Measurement of plasma norepinephrine and plasma renin activity.
- Correlation analysis between renal function, blood pressure control, therapy duration, and neuroendocrine markers.
Main Results:
- Nine of 20 patients experienced a significant increase in serum creatinine (>1 mg/dl), with 4 progressing to hemodialysis.
- Eleven patients showed no significant renal function decline; 3 with prior malignant hypertension and renal failure experienced reversal.
- Higher plasma norepinephrine and lower plasma renin activity were observed in patients with renal disease progression.
- Serum creatinine correlated with plasma norepinephrine levels.
Conclusions:
- Long-term minoxidil-based therapy can be associated with progressive renal disease in a subset of refractory hypertensive patients.
- Elevated plasma norepinephrine, potentially due to increased release rather than impaired renal clearance, may be linked to renal deterioration.
- Further research is needed to elucidate the causal relationship between elevated norepinephrine and renal disease progression in hypertension.