No concomitant drug therapy was. Mitchell, 1973; Sannetstedt, Brorson, Berglund & given except the thiazide*. Minoxidil was administered in a dose of 2.5 mg.
Clinical Science and Molecular Medicine (1976) 51, 5919-592s.
Clinical and haemodynamic study of minoxidil in moderately hypertensive patients H. B R E N L U N D J E N S E N , K . R A S M U S S E N A N D N . M O S B E K Medical Department C, Diakonissestiftelsen, Copenhagen, Denmark
summary 1. We have evaluated the effectiveness and safety of minoxidil in moderately hypertensive out-patients. Eight patients were treated with hydrochlorothiazide and minoxidil for 5 months. The only female patient developed slight, reversible facial hair growth. In the other seven patients there was a moderate decrease in blood pressure. There were only minimal sideeffects. Mild exertional tachycardia and a mean increase in body weight of 0.5 kg was found, but no uedema or signs of cardiac insufficiency were observed. No abnormalities were seen during routine blood tests. 2. This study shows that minoxidil combined with a diuretic may be successfully used in treating moderately hypertensive male patients.
Our study, which is part of a multi-centre study, was designed to evaluate the effectiveness and safety of minixodil in the treatment of ~ ~ d e r a t e hypertensive patients.
Methods Eight patients, one female and seven male, all outpatients with mean age 58 years (53-67) entered the study. Before treatment with minoxidil the blood pressure had been repeatedly measured for at least 6 weeks on hydrochlorothiazide (50 mg daily) to establish a pretreatment level. Blood pressure and pulse rate were measured supine after 5-10 min rest, standing after 2 min and after 1 min exercise (squatting). Initial supine blood pressure was 196/115 Key words: cardiac output, essential hypertension, mmHg (25&163/13&109). hypertrichosis, minoxidil. All the patients had essential hypertension, present for 0-1 year in two, 1-5 years in three and 5-10 years in three. Chest X-ray was normal in six, and Introduction Minoxidil, a piperidinopyrimidine derivative, is a in the remaining two patients a slightly enlarged very potent peripbra~ vasodi\ator with a direct heart was found. ECG showed left ventricular relaxant effect on vascular smooth muscle. The drug hypertrophy in three and was normal in the Other five patients. Grade 1 fundal changes were seen in has a slow onset of action. previous studies have mostly been concerned two Patients and grade 2 in Six (Keith Wagner). with the use of minoxidil in severe hypertension Serum creatinine was 1.C2.8 mg/100 ml (mean 1.5). especially associated with renal failure, where the Before treatment and after and months Of drug has been shown to be very effective and to treatment complete blood and platelet count, sediurinalysis, electrolytes, renal and ~ ~ young ~ ~ mentat ~ ion i rate, ~ , reduce the need for nephrectomy ( liver function, ECG and chest X-ray examinations & Neis, 1975; Gottlieb, Katz & Chidsey, 1972; ~i~~ & ~ ~1973;i pdersen, ~ , 1975; Pettinger & were carried out. No concomitant drug therapy was given except the thiazide* Mitchell, 1973; Sannetstedt, Brorson, Berglund & Minoxidil was administered in a dose of 2.5 mg Werke, 1975; Wilburn, Blaufuss & Benett, 1975). twice daily initially; thereafter the dose was inCorrespondence: Dr H . Erenlund lensen, Medical Departcreased as necessary. Mean daily dose after ment C, Diakonissestiftelsen, Peter Bangsvej I , 2000 Copenmonths' treatment was 14.3 mg (range 11-20 mg). hagen F, Denmark. 591s
H . Erenlund Jensen, K . Rasmussen and N . Mosbak
592s
TABLEI . Effect of 3 months and 6 months treatment with minoxidil on blood pressure in hypertensive patients
Blood pressure (mmHg) Supine
Standing
Exercise
Dose of minoxidil (mg/day)
212/128 178/108 147/93
13.1 14.3
~~
Pretreatment 3 months 6 months
196/115 170/106 157/97
185/122 160/104 152196
Results
A moderate decrease in blood pressure was observed in all patients (Table 1). The mean decrease was similar in the supine and standing position and after exercise. Only mild exertional tachycardia without palpitations was observed. An average increase in weight of 0.5 kg was found, but no oedema or signs of cardiac insufficiency were seen. Blood tests remained normal. Treatment had to be stopped in the female patient after 2 months because of slight facial hair growth. This disappeared in a few weeks of stopping minoxidil treatment. No other side effects were seen except the above-mentioned gain in weight.
Discussion The study shows that minoxidil combined with a diuretic may be used in moderate hypertension. The side effects from the increase in cardiac output after
peripheral vasodilatation were small, presumably due to the small dose of minoxidil administered. The decrease in blood pressure was not quite satisfactory and propranolol has been added to the treatment in order to improve blood pressure control. Owing to the development of hypertrichosis in the female patient, we have decided not to use minoxidil in female patients unless other drugs have failed. As drugs with sufficient potency and less side effects exist, such as hydrallazine and prazosin, treatment with minoxidil should still be reserved for patients with severe hypertension, especially of renal origin.
References DORMOIS, J.C., YOUNG,J.L. & NIES,A.S. (1975) Minoxidil in severe hypertension: value when conventional drugs have failed. American Heart Journal, 90, 36&368. GOTTLIEB, T.B., KATZ,F.H. & CHIDSEY, C.A. (1972) Combined therapy with vasodilator drugs and beta-adrenergic blockade in hypertension. Circulation, 45, 571-582. LIMAS, J.L. & FRIES,E.D. (1973) Minoxidil in severe hypertension with renal failure. American Journal of Cardiology, 31,355-361.
PEDERSEN, O.L. (1975) Treatment o f severe hypertension with minoxidil combined with beta-blockade and diuretics. Ugeskrift for Lager, 138, 10-14. PETTINGER, W.A. & MITCHELL, H.C. (1973) Minoxidil-an alternative to nephrectomy for refractory hypertension. New England Journal of Medicine, 2S9, 167-1 71. SANNERSTEDT, R., BRORSON, L., BERGLUND, G . & WERKB, L. (1975) Minoxidil-haemodynamic and clinical experiences with a new peripheral vasodilator. Acta Medica Scandinauica, 197, 409414. WILBURN, R.L., BLAUFUSS, A. & BENETT, C.M. (1975) Longterm treatment o f severe hypertension with minoxidil, propranolol and frusemide. Circulation, 52, 706-71 3.
