Use of Minoxidil in the Azotemic Patient

Abstract

Twenty-seven azotemic patients with severe hypertension resistant to the usually employed antihypertensive drugs received from 5 to 60 mg of minoxidil daily in combination with other antihypertensive drugs for 3 days to 144 weeks. At the time minoxidil treatment began, the mean age of the 27 was 44 (range, 16–65) years; 18 were black, and 18 were men. Their serum creatinine levels averaged 6.4 mg/dl (range, 1.7–17.1). Fifteen had hemorrhages and/or exudates in their ocular fundi, and 6 were being hemodialyzed. After 1 month of minoxidil treatment the average fall in supine blood pressure was 27/23 mm Hg. From the last value before minoxidil to the last value during minoxidil, an average of 40 weeks, the serum creatinine concentration rose an average of 0.8 mg/dl. For the 19 patients who were never dialyzed, the increase averaged 1.1 mg/dl, and for the 8 patients who were dialyzed, there was a decrease of 0.2 mg/dl. Eleven patients discontinued minoxidil after 3 days to 35 weeks: 3 because their hypertension was controlled with other drugs during dialysis: 2 after nephrectomies because their blood pressure could not be controlled; 1 following renal transplantation; 1 each because of hirsuitism, massive congestive heart failure, and hypotension; and 2 because of refusal to continue the regimen or moving out of the area. Four patients died on minoxidil: 2 from end-stage renal disease after 4 and 17 weeks, 1 from bronchopneumonia after 3 days, and 1 with a previous history of myocardial infarction from acute cardiorespiratory arrest after 3 weeks.