[Treatment of arterial hypertension by plasmapheresis]

Plasmapheresis may induce transient hypotension in some patients. It may also be beneficial to patients presenting Raynaud's phenomenon where its effect may be explained by an improvement in the microcirculation due to decreased blood viscosity. Intrarenal microcirculation may be altered in patients who have impaired renal function, high plasma renin activity values and hypertension. Two such patients have been treated by plasmapheresis after unsuccessful multiple drug treatment. Blood pressure decreased to normal values after 2 or 3 plasmaphereses and drug treatment could be reduced. Twelve months after this treatment the blood pressure was still normal. Renal function was improved in one patient and unchanged in the other. Plasma renin activity, which was high before plasmapheresis, decreased dramatically but was not within normal limits after 8 exchanges. These two observations are preliminary but they render certain hypotheses possible. The decrease in plasma renin activity and improvement in renal function may be due to improved microcirculation. When blood pressure is not controlled by multiple drug antihypertensive treatment, plasmapheresis may be considered as an alternative therapeutic procedure.