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PubMed1986

Nifedipine tablet vs. hydralazine in patients with persisting hypertension who receive combined diuretic and beta-blocker therapy.

The antihypertensive effects of a 20 mg tablet of nifedipine were compared with those of hydralazine in a randomized, double-blind, placebo-controlled study. Nineteen patients with a diastolic blood pressure (BP) between 95 and 120 mm Hg despite combined diuretic and beta-blocker therapy completed the protocol. After 2 weeks of placebo each subject received increasing doses of nifedipine (20, 40, and 60 mg b.i.d.) and hydralazine (25, 50, and 100 mg b.i.d.) if tolerated or until goal BP (supine and standing diastolic BP less than 85 mm Hg) was achieved. Both nifedipine and hydralazine significantly lowered supine BP from placebo baseline (146 +/- 3/96 +/- 2 mm Hg) to 119 +/- 3/80 +/- 2 and 129 +/- 2/81 +/- 2 mm Hg, respectively. The decrease in systolic BP with nifedipine was significantly lower than that with hydralazine at 9 weeks. Neither drug significantly altered heart rate. Mean left ventricular ejection fractions were similar for nifedipine (67% +/- 2%), hydralazine (69% +/- 3%), and placebo (66% +/- 2%). The nifedipine tablet appears to be an effective antihypertensive agent in patients whose BP remains high despite combined diuretic and beta-blocker therapy.

Administration, Oral↗
PubMed1990

Quality of life among hypertensive patients with a diuretic background who are taking atenolol and enalapril.

The cardioselective beta-blocker atenolol and the angiotensin-converting enzyme inhibitor enalapril were compared for efficacy, safety, and quality-of-life factors in 30 patients with hypertension whose hypertension was inadequately controlled with diuretic alone. Atenolol (50 to 100 mg once a day) and enalapril (2.5 to 40 mg once a day), combined with hydrochlorothiazide (25 mg once a day), had similar levels of efficacy and safety. A comprehensive battery of psychologic assessments for quality of life was administered, including measures of anxiety, depression, psychiatric symptoms, memory, and psychomotor function. These five conceptually based clusters were first analyzed by multivariate analysis of variance procedures, followed by univariate analyses of the individual variables composing each domain. In general, neither atenolol nor enalapril was associated with major changes in psychologic functioning. The only data cluster with a statistically significant change was memory function, primarily as a result of lower scores of the digit span (backward) test, for atenolol relative to enalapril. These preliminary findings suggest that atenolol and enalapril have comparable degrees of efficacy and safety, with no major disparities in quality-of-life effects, for hypertensive patients with a history of taking diuretics and this sort of quality-of-life assessment can be performed during trials of antihypertensive drugs.

Analysis of Variance↗
PubMed1979

Renal transport of oxalate: effects of diuretics, uric acid, and calcium.

Clearance experiments were performed in the rat to examine the effects of diuretics on the renal transport of oxalate. In addition, the effect of infusing either uric acid or calcium on the renal transport of oxalate was examined. During control periods, the fractional excretion of oxalate (FEOx) averaged 118.0 +/- 2.1%. Acute administration of either chlorothiazide, furosemide, or indanyl-oxyacetic acid (MK-196), a new uricosuric diuretic, resulted in a significant decrease in the FEOx in all groups to 104.8 +/- 2.4%, 111.3 +/- 2.1%, and 108.6 +/- 2.7%, respectively. Infusion of uric acid increased urinary uric acid excretion from 2.41 +/- 0.28 to 4.26 +/- 0.03 micrograms/min/g kidney wt (P less than 0.001) and decreased FEOx to 104.0 +/- 2.4% (P less than 0.001 compared to control). Infusion of calcium chloride increased urinary calcium excretion from 0.10 +/- 0.04 to 0.44 +/- 0.06 micrograms/min/g kidney wt (P less than 0.001) but had no effect on the FEOx which averaged 118.3 +/- 8.3% (P = NS compared to control). These studies show that the acute administration of chlorothiazide, furosemide, or MK-196, as well as increasing urinary uric acid excretion by uric acid infusion, are all associated with a decrease in the FEOx. Acutely increasing urinary calcium excretion, however, had no effect on oxalate transport.

Animals↗
PubMed1987

Comparison of loop diuretics in patients with chronic renal insufficiency.

Furosemide and bumetanide share a number of characteristics including reduced natriuretic effects in azotemic patients. It has been presumed that this condition affects each drug equally. Previous studies, however, suggest dissimilar pathways of delivery to their sites of action. Though not rigorously tested, this potential disparity might cause them to differ when used in azotemia. We, therefore, assessed the pharmacokinetic and pharmacodynamic characteristics of intravenously administered furosemide and bumetanide in ten adult patients with stable, chronic renal insufficiency (mean creatinine clearance = 14.1 +/- 2.0 ml/min/1.73 m2) in a randomized, cross-over study during controlled sodium intake. Our goals were to assess differences in diuretic effectiveness and in so doing to determine the dose required to produce a maximal response. The mean diuretic doses of 172 and 4.3 mg for furosemide and bumetanide, respectively (ratio = 40:1) were sufficient to produce a maximum response. Despite similarities in maximal fractional excretion of sodium (18.2 +/- 2.6% with furosemide vs. 19.4 +/- 4.5% with bumetanide, P = 0.687) demonstrating an equal tubular responsiveness to both drugs, overall response as quantified by cumulative natriuresis in the initial eight hour period was 52% greater with furosemide (108 +/- 17 vs. 71 +/- 7 mEq; P = 0.042). The difference in total excreted sodium was accounted for by a preserved nonrenal clearance of bumetanide (113 +/- 12 compared to 53 +/- 5 ml/min for furosemide, P = 0.001) which resulted in relatively less bumetanide in serum available to be delivered into the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Effect of diuretics on cell potassium transport: an electron microprobe study.

To study the short-term uptake of potassium across the basolateral membrane into individual tubule cells, rubidium was used and measured by electron microprobe analysis. Changes of rubidium uptake were interpreted to reflect altered sodium entry and basolateral Na-K-ATPase activity. The effects of hydrochlorothiazide, amiloride and furosemide were determined in saline-loaded animals. Hydrochlorothiazide inhibited rubidium uptake in proximal convoluted and distal convoluted tubule cells. The effect was largest in distal convoluted tubule cells. Amiloride reduced rubidium uptake in principal cells as well as in proximal convoluted, distal convoluted and connecting tubule cells. Furosemide depressed rubidium uptake in distal convoluted tubule cells, but increased uptake in principal cells. Rubidium uptake into intercalated cells was not affected by any of the diuretics used. Hydrochlorothiazide and amiloride altered rubidium uptake also in cells not associated with the main diuretic action. These effects of hydrochlorothiazide and amiloride may be due to interference with cell transport mechanisms of Na-H and anion exchange.

Animals↗
PubMed1992

Effects of ACE inhibition supplementary to beta blockers and diuretics in early diabetic nephropathy.

Angiotensin converting enzyme (ACE) inhibition has shown promising results in diabetic nephropathy, but long-term results on survival are not available. In a cohort of patients receiving antihypertensive treatment predominantly consisting of beta blockers in combination with diuretics, support for an improved survival has been presented. Addition of ACE inhibition to such a combination treatment may be favorable both due to the suggested renoprotective effects of ACE inhibitors and because diuretics activate the renin-angiotensin system. In 10 insulin-dependent diabetic patients with early diabetic nephropathy [urinary albumin excretion rate (UAE) less than 100o micrograms/min], who were receiving continuous therapy with metoprolol and bendroflumethiazide, a double-blind crossover study with four months addition of ramipril 5 mg (Ramace) and placebo was conducted. UAE (radioimmunoassay) and fractional albumin excretion were significantly reduced after the four months of ramipril administration [UAE: 114.1 x/divided by 1.3 (geometric mean x/divided by confidence factor] versus 174.6 x/divided by 1.2 micrograms/min, 2P less than 0.005). Renal plasma flow (clearance of 131I-hippuran) tended to increase [497 +/- 25 (mean +/- SE) vs. 464 +/- 28 ml/min/1.73 m2, 2P = 0.08], while GFR (125I-iothalamate) stayed unchanged (121 +/- 8 vs. 120 +/- 9 ml/min/1.73 m2). Mean arterial pressure during clearance studies fell moderately (95 +/- 3 vs. 101 +/- 1 mm Hg, 2P less than 0.05) and renal resistance was decreased (2P less than 0.03). ACE activity was suppressed in all patients. Twenty-four-hour ambulatory blood pressure measurements were not significantly different after the two periods (daytime averages: 91 +/- 2 vs. 93 +/- 2, nighttime 80 +/- 2 vs. 84 +/- 3 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed2005

New concepts in blood pressure-lowering management in diabetic patients: the case for early ACE inhibitor combination therapy with diuretics.

Type II diabetes and the dysmetabolic syndrome are becoming more and more prevalent, not only in the Western world, but also in many developing countries. The key issue is early prevention and treatment, not only antihyperglycaemic and antihyperlipidaemic treatment, but also, and maybe in particular, antihypertensive treatment. The first issue is first of all screening patients for elevated blood pressure and for microalbuminuria, especially if blood pressure elevation or diabetes is present. Especially, diabetic patients are at risk. The key feature in the therapeutic approach is blocking the renin-angiotensin system, which has proven effective in many original studies. Also the combination with diuretics is a key issue, since these patients have sodium retention. It has been discussed whether ACEi, ARBs or diuretics should be initial treatment, but usually a combination treatment is recommended to reduce blood pressure early and efficiently. The PREMIER study emphasized combination therapy, since the study had very efficient outcomes with combination therapy compared to an ACEi alone as far as blood pressure lowering is concerned, but also with reduction in microalbuminuria and, indeed, end point-reduction. Cardiovascular events showed a decreased incidence with the combination therapy with Preterax (perindopril/indapamide) compared with the enalapril group.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1978

Raised serum lipid concentrations during diuretic treatment of hypertension: a study of predictive indexes.

1. The serum concentrations of cholesterol and triglycerides were measured before and during the treatment of hypertension. Thirty-six patients were treated with hydrochlorothiazide and 29 with spironolactone. 2. Serum cholesterol increased from 214 to 227 mg/100 ml (P less than 0.005) and triglyceride did not change during treatment with hydrochlorothiazide. Serum triglyceride increased from 112 to 133 mg/100 ml (P less than 0.05) and cholesterol did not change during treatment with spironolactone. 3. Serum lipid responses to diuretics varied among patients. To identify patients susceptible to larger increases, subgroup analysis was carried out. Patients who were younger and had lower pretreatment serum cholesterol and systolic blood pressure had larger increments in cholesterol during treatment. In these subgroups coronary risk status did not improve during therapy. 4. The incidence of myocardial infarction may not be reduced so long as diuretics serve as first-line drugs in the treatment of mild hypertension.

Adult↗
PubMed1991

Effects of diuretics on stroke development in Kyoto-Wistar stroke-prone spontaneously hypertensive rats.

1. Previous studies have indicated that increases in dietary K+ promote diuresis and retard stroke development in stroke-prone spontaneously hypertensive rats (spSHR) fed a Japanese-style diet containing 4% NaCl. 2. It is possible that elevations in dietary K+ retard stroke development by inducing natriuresis and facilitating the clearance of Na+, and that diuretics associated with natriuresis might also be capable of retarding stroke development in spSHR. To test if this was the case, the onset of stroke development in spSHR fed a low (0.75%) K+ diet containing 4% NaCl (controls) was monitored and compared with that in spSHR treated with (a) frusemide, (b) chlorothiazide, (c) amiloride or (d) acetazolamide, and with (e) untreated spSHR fed a high (2.11%) K+ diet. 3. The onset of stroke, as well as death resulting from stroke, occurred at a significantly later age in spSHR fed a high K+ diet than in spSHR fed a low-K+ diet, despite the fact that both groups of spSHR rats had comparable blood pressures. 4. Treatment of spSHR with the above-named diuretics before stroke development did not alter the blood pressure of the rats. The onset of stroke development and death in spSHR treated with chlorothiazide, amiloride or acetazolamide was comparable with that observed in untreated control spSHR. In spSHR treated with frusemide, the onset of stroke was comparable with that of untreated control spSHR, whereas the onset of death after stroke development was accelerated. 5. Post mortems performed on spSHR that developed stroke indicated the presence of haemorrhagic stroke of comparable severity in the six groups of spSHR studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetazolamide↗
PubMed2003

Development, implementation and cost-effectiveness of a protocol for review of combination diuretic prescribing.

AIMS: To determine the extent of inappropriate prescribing of combination diuretics and the cost implications of protocol implementation. METHODS: Pharmacist-run medication review clinics in two general practices in Bradford, UK. RESULTS: Sixty-one patients, mean +/- s.d. age 75.8 +/- 12.0 years, were reviewed. Thirty-six met protocol criteria; 30 (49.2%) patients had their potassium-sparing diuretics (PSDs) discontinued. Mean (95% confidence interval) reduction in serum potassium concentrations after intervention in these 30 patients was 0.26 (0.09, 0.43) mmol l(-1) (P < 0.01). Twenty-eight (93.3%) patients were within the reference range at follow-up; none was below. CONCLUSIONS: Of prescribed PSDs, 59% were found to be unnecessary. Using the developed protocol potentially improves drug safety and enables cost savings.

Adult↗
PubMed2001

Increased bone mineral density in a population-based group of 70-year-old women on thiazide diuretics, independent of parathyroid hormone levels.

BACKGROUND: Several studies have shown greater bone mineral density (BMD) in people receiving thiazide diuretics compared with controls. Most researchers have related this association to the hypocalciuric effect of thiazides with subsequent rise in serum calcium and fall in parathyroid hormone (PTH) levels. Recent experimental evidence suggests, however, a direct effect of thiazides on osteoblast-like cells. OBJECTIVE: To test the hypothesis that the association of thiazides and raised BMD is independent of PTH levels in humans. SUBJECTS: A population-based group of 248 70-year-old Icelandic women, 51 receiving thiazide diuretics, 39 receiving other antihypertensive therapy and the rest acting as controls. MAIN OUTCOME MEASURES: The independent contribution of thiazide usage and PTH to BMD in a multivariate analysis. RESULTS: The mean BMD was 9.6% greater in the lumbar spine (P < 0.01) and 5.4% greater in the whole skeleton (P < 0.01) amongst thiazide users than in controls, reduced to 7.6% (P < 0.02) and 4.5% (P < 0.01), respectively, when corrected for fat mass which was 5.8 kg greater in the thiazide group. In a multivariate analysis, corrected for body weight and body composition, serum calcium and ln-PTH, thiazides remained a significant independent predictor of BMD in the total skeleton and lumbar spine, but not in the total hip or femoral neck. Thiazides explained about 3% of the variability in whole body and lumbar spine BMD. CONCLUSIONS: Thiazides augment or preserve BMD independent of PTH, implying other mechanisms.

Aged↗
PubMed2003

Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study.

BACKGROUND: Noncompliance is a major factor in the morbidity and unnecessary hospital readmissions for patients with heart failure. Several studies have aimed to reduce rehospitalizations in heart failure patients through a comprehensive, multidisciplinary approach. Medication compliance was rarely measured in these studies or, when it was measured, the method employed was seldom valid. We aimed at determining the effect of a pharmacist-led intervention on medication compliance in patients with heart failure. METHODS: We conducted a randomized controlled trial into the effect of a pharmacist-led intervention on medication compliance in patients with heart failure (predominantly New York Heart Association [NYHA] II and III) treated with loop diuretics, presenting to a cardiology outpatient clinic or admitted to hospitals in The Netherlands. Patients in the intervention group received monthly consultations from their community pharmacist during a 6-month period. Patients in the control group received usual care. Primary endpoint was medication compliance, assessed with a medication event monitoring system, an electronic pill bottle that registers time of opening. Secondary endpoints were the number of rehospitalizations, death, and quality of life. RESULTS: A total of 152 patients were randomized: 74 patients to the intervention arm and 78 patients to the usual care arm. Over the 6-month study period, patients in the intervention group had 140/7656 days without use of loop diuretics compared with 337/6196 days in the usual care group (relative risk 0.33 [confidence interval (CI) 95% 0.24-0.38]). Two consecutive days of nondosing occurred on 18/7656 days in the intervention group compared with 46/6196 days in the usual care group (relative risk 0.32 [CI 95% 0.19-0.55]). There were no significant differences in rehospitalizations, mortality, or disease-specific quality of life between groups. CONCLUSIONS: A pharmacy-led intervention can improve medication compliance in patients with moderate to severe heart failure, even in those with relatively high compliance. Future interventions should also focus at less compliant patients.

Aged↗
PubMed1977

[Hyperreninism without hyperaldosteronism in diuretic abuse: a report of a case with identification of mefruside and ethacrynic acid in urine (author's transl)].

A 46-year-old nurse had been hospitalized 16 times during the preceding five years because of episodes of excessive hypokalaemia. On admission to hospital there was hypokalaemia, polyuria, excessive plasma renin activity but no increased aldosterone secretion rate. Diuretic abuse was confirmed by gas-chromatography and mass spectrometry of mefruside and ethacrynic acid in the patient's urine. Apart from other interesting aspects of this case there was the demonstration of hyperreninism without hyperaldo-steronism. The stimulating effect of renin on aldosterone secretion was obviously lower than the inhibiting effect of hypokalaemia. The general term "renin-angiotensin-aldosterone system" is, therefore, misleading because it mentions only one pathway of aldosterone regulation. The combination of hypokalaemia, polyuria, hyperreninism without hyperaldosteronism is apparently the principal but not widely recognised feature of diuretic abuse.

Aldosterone↗
PubMed2001

Multi-slice CT urography after diuretic injection: initial results.

PURPOSE: To investigate the feasibility of CT urography (CTU) using a multi-slice (MS) scanner and to find out whether a low-dose diuretic injection is advantageous for the opacification of the urinary tract. METHODS: MS-CTU was performed in 21 patients with urologic diseases. In 5/21 patients, 250 ml of physiologic saline Solution were injected. In 16/21 patients, 10 mg of furosemide were injected 3-5 min before contrast material administration. A 4 x 2.5 mm collimation with a pitch of 1.25 and a tube current of 100-150 mA were used. Scan time was 12-16 sec. 3 mm thin axial images with an overlap of 67% were reconstructed. Multiplanar maximum intensity projection (MIP) images were postprocessed to obtain urographic views. Bone structures were eliminated using the volume-of-interest method. RESULTS: Furosemide-enhanced MS-CTU achieved either near complete or complete opacification in 30/32 (94%) ureters and in 32/32 (100%) pelvicaliceal systems up to a serum creatinine of 150 mumol/l. In our series, only one CTU scan per patient was needed to obtain a diagnostic urogram after 10 min of contrast material injection. Ureteral compression was not necessary. When physiologic saline solution was used instead of furosemide, the radiopacity inside the enhanced pelvicalices was 4-5 times higher and more inhomogeneous. Diuretic-enhanced MS-CTU was more accurate in the depiction of pelvicaliceal details. In combination with furosemide, calculi were well identified inside the opacified urine and were safely differentiated from phleboliths. Postprocessing times of up to 20 minutes were problematic as were contrast-enhanced superimposing bowel loops on MIP images. CONCLUSION: Preliminary results demonstrate a good feasibility of furosemide-enhanced MS-CTU for obtaining detailed visualization of the entire upper urinary tract.

Adult↗
PubMed2001

Prolonged exercise following diuretic-induced hypohydration effects on fluid and electrolyte hormones.

To investigate the hypothesis that a reduction in plasma volume (PV) induced by diuretic administration would result in an increase in the fluid and electrolyte hormonal response to exercise, ten untrained males (VO(2) peak = 3.96 +/- 0.14 l/min) performed 60 min of cycle ergometry at 61 % VO(2) peak twice. The test was carried out once under control conditions (CON) (placebo) and once after 4 days of diuretic administration (DIU) (Novotriamazide; 100 mg triamterene and 50 mg hydrochlorothiazide). Calculated resting PV decreased by 14.6 +/- 3.3 % (p < 0.05) with DIU. No difference in plasma osmolality was observed between conditions. For the hormones measured, differences (p < 0.05) between conditions at rest were noted for plasma renin activity (PRA) (0.62 +/- 0.09 vs. 5.61 +/- 0.94 ng/ml/h), angiotensin I (ANG 1) (0.26 +/- 0.03 vs. 0.56 +/- 0.08 ng/ml), aldosterone (ALD) (143 +/- 14 vs. 1603 +/- 302 pg/ml), arginine vasopressin (AVP) (4.13 +/- 1.1 vs. 9.58 +/- 1.6 pg/ml) and atrial natriuretic peptide (alpha-ANP) (11.5 +/- 2.8 vs. 6.33 +/- 1.0 pg/ml). The exercise resulted in increases (p < 0.05) in PRA, ANG I, ALD, AVP, alpha-ANP. DIU led to higher levels of PRA, ANG I, and ALD (p < 0.05) and lower levels of alpha-ANP (p < 0.05) compared to CON. Arginine vasopressin was not affected by the loss of PV. For the catecholamines--norepinephrine (NE) and epinephrine (EPI)--only NE was higher during exercise with DIU compared to CON (p < 0.05). For PRA and ALD, the higher levels observed during exercise with DIU could be explained both by higher resting levels and a greater increase during exercise itself. For ANG I and NE, the effect of DIU only manifested itself during exercise. In contrast, the lower alpha-ANP observed during exercise with DIU was due to the lower resting levels. These results support the hypotheses that hypohydration leads to alterations in the secretion of all of the fluid and electrolyte hormones with the exception of AVP. The specific mechanisms of these alterations remain unclear, but appear to be related directly to the decrease in PV.

Adult↗
PubMed2004

[Simulation of a colon carcinoma: diuretic-induced ulcerative-stricturing ischemic colitis].

HISTORY AND ADMISSION FINDINGS: A 49-year-old man was admitted to hospital with lower gastro-intestinal bleeding. He complained of fatigue, weight loss and bloody stools for a few days. There was no history of abdominal pain, but he had irregular bowel movements for some weeks with alternating constipation and diarrhea. He regularly took furosemide and ACE inhibitors for hypertension. The abdominal investigation was unremarkable. INVESTIGATIONS: Laboratory investigations showed a significant anemia (Hb 6,3 g/dl), WBC, C-reactive protein and lactic acid were normal, carcino-embryonic antigen was 38 ng/ml and thus increased (normal value: < 5 ng/ml). Colonoscopy revealed a circular stricturing and ulcerating tumor at 70 cm, which looked highly suspicious for malignancy and could not be passed endoscopically. Biopsies showed high-grade dysplasia and colon contrast x-ray confirmed a stricturing tumor. TREATMENT AND COURSE: Laparotomy was performed for a bleeding colon carcinoma. However, besides multiple inflammatory-stenosing strictures of different parts of the right colon, no tumor was found. Perfusion of the small and large bowel was normal. A right colectomy was performed and multiple deep ulcerations and strictures were found inside the resected colon. A cecal ulceration was the origin of the bleeding. After stopping furosemide intake no further bleeding or colonic ulceration occurred. CONCLUSION: This is an unusual case of drug related non-occlusive, ulcerative-stricturing, ischemic colitis, masquerading as colonic cancer. Although diuretic-induced non-occlusive ischemic colitis is a very rare finding, it should be taken into account in young patients with ischemic colitis, when other risk factors have been excluded and intake of diuretics is reported.

Colectomy↗
PubMed1997

[T1-weighted excretory MR urography using GD-DTPA after low-dose diuretic administration].

PURPOSE: Assessment of the morphology of the urinary tract by gadolinium (Gd)-enhanced T1-weighted MR-urography (MRU) and precontrast diuretic injection. METHODS: MRU was performed in 5 patients using Gd-DTPA-enhanced coronal T1-weighted 3D-gradient-echo sequences with different spatial resolution. Prior to contrast injection, 10 mg of furosemide were administered intravenously. RESULTS: Secondary to the precontrast furosemide injection, the increase of the renal excretion rate allows complete visualisation of the entire collecting system within 10 minutes following Gd injection. Maximum intensity projections provide a three-dimensional overview of the ureters separate from the bladder. To achieve detailed anatomic imaging of the calices, both optimal distension and high resolution sequences are prerequisites which cannot be realized by means of survey urograms only. CONCLUSIONS: Contrast-enhanced excretory MRU performed after injection of a diuretic offers a rapid approach to visualising the morphology of the nondilated urinary tract. Imaging of caliceal details must be done with high-resolution 3D-gradient-echo sequences.

Adult↗
PubMed1975

Beta-adrenergic blockade in diuretic-treated patients with essential hypertension.

The influence of beta-adrenergic blockade (160 mg per day of propranolol for four weeks) on plasma renin activity, plasma volume, and arterial pressure was explored in 20 patients with essential hypertension with hyper-reninemia from long-term diuretic therapy. In 15 of these patients renin activity remained elevated (range, 3.1 to 23.0 ng per milliliter). Plasma volume was unchanged in eight, increased in 11 and reduced in one. In 17 subjects mean arterial pressure decreased by more than 10 mm Hg, but these impressive reductions could not be explained by quantitative changes in either renin activity (r equals 0.1) or plasma volume (r equals 0.1). These data suggest that suppression of plasma renin activity by beta-adrenergic blockade is not attainable during diuretic therapy and is not the major factor responsible for the antihypertensive action of propranolol.

Adrenergic beta-Antagonists↗