Conventional Antihypertensive Drugs Research Articles

Low Dose Administration of Captopril in Severely Hypertensive Children

AbstractCapopril, an oral angiotensin‐1‐ converting anzyme inhibitor, was administered to 8 severely hypertensive children. Three children did not respond to other conventional antihypertensive drugs. According to our protocol, patients who weighed 10 kg or less were given one half tablet, and those of over 10 kg were given one tablet in order to alleviate hypertensive crisis. There was a dramatic drop in blood pressure (BP) withing 30 minutes of administration of an anitial low dose of captopril (0.5–1.4mg/kg). The BP was stabilized to withing normal limits for two hours, and thereafter, the BP returned to the previous level after four hours. After administration of an initial dose of captopril, the BP was controlled by contined therapy of captopril alone with the exception of two cases to whom other antihypertensive were given in combination with captopril. Four cases with low renin activity responded as well to captopril as other with high renin activity did. Although captopril was given to two cases with nephrotic syndrome, there was no exacerbation of proteinuria. The only side effect was a skin eruption in one child who received long‐term treatment. We conclude that even a low dose of captopril is very effective in the control of both hypertensive crisis and of hypertensive children refractory to ther potent antihypertensive drugs.

The outpatient treatment of refractory hypertension with minoxidil.

Minoxidil is a potent orally administered vasodilator under investigation for use in severe hypertension. Fifteen patients with moderate to severe hypertension refractory to conventional antihypertensive drugs were treated with minoxidil on an outpatient basis. Propranolol and furosemide were administered concomitantly to control reflex tachycardia and fluid retention. Good blood pressure control was achieved in all but one patient with the average supine mean arterial blood pressure falling from 140 mm Hg with conventional drugs to 106 mm Hg with minoxidil (P less than 0.0005). The major side effects of fluid retention (9/15), hirsutism (15/15), and tachycardia were adequately controlled in all but one patient. We conclude that minoxidil will be a valuable drug in the outpatient management of refractory hypertension.

Side Effects of Minoxidil-Reply

In Reply.— It is only fair to point out that the patient in question has been on maintenance dialysis for three years, and that she has had no complications and has never required admission to the hospital. Once her blood pressure was controlled with minoxidil, she was able to return to nearnormal life and was spared the side effects of maximal doses of conventional antihypertensive drugs. We believe now, however, that we were mistaken to include the old photograph, and we compounded the error by implying that it was taken several months before minoxidil treatment was started, when in fact it was taken several months before the onset of dialysis. We tried to show the hypertrichosis and skin changes, but the general change in appearance actually reflects many months of untreated hypertension as well as the time spent receiving dialysis. Even so, it is questionable whether because of sensitivity to

Minoxidil in refractory hypertension

A life-threatening, severe, hypertension refractory to conventional antihypertensive drugs developed in a 10-year-old girl in association with a functional renal transplant. Minoxidil, a new vasodilator, proved to be a life-saving antihypertensive drug and prevented the removal of the functional transplant. During 9 months of minoxidil therapy the blood pressure remained controlled and the renal transplant function excellent. No serious side effects except a moderate hypertrichosis have been observed. It appears that minoxidil can be used to control refractory, life-threatening hypertension in children.

Minoxidil in severe hypertension with renal failure: Effect of its addition to conventional antihypertensive drugs

Minoxidil, a new vasodilator antihypertensive compound, was given to 9 uremic patients with severe hypertension uncontrollable with currently available drugs. Addition of minoxidil in doses of 5 to 10 mg twice daily to their prior therapy, resulted in satisfactory control of blood pressure in all patients. Supine blood pressure fell from a control value of 200 ± 6/124 ± 3 to 164 ± 5/91 ± 2 mm Hg (mean and standard error) after administration of minoxidil, and no patient experienced orthostatic hypotension. Tachyphylaxis has not been seen during a follow-up period averaging 26 weeks. Side effects resulting from minoxidil have been limited to mild hypertrichosis in 2 patients, nausea in another 2 and fluid retention, which was readily controlled by either hemodialysis or furosemide. Minoxidil appears, therefore, to provide a means for controlling blood pressure in patients with severe hypertension resistant to all other antihypertensive drugs.