Abstract
Forty seven patients with advanced or malignant hypertension were divided into renin dependent and independent groups based on the response to angiotensin II antagonist, and then hypotensive effectiveness of several kinds of antihypertensive drugs were evaluated in each group. Twenty nine patients were treated principally with propranolol and furosemide. Fifteen out of them were found to respond to angiotensin II antagonist and classified into the renin dependent group, and the remaining 14 patients were non-responders and classified into the renin independent group. Most responders were patients with essential hypertension, while the half of the non-responders were patients with chronic glomerulonephritis. The main difference between the responders and the non-responders was in the level of plasma renin activity, that is, it was higher in the former than in the latter. The responders were treated principally with propranolol. Two thirds of them were treated successfully with combination of propranolol and either furosemide, clonidine or hydralazine. However, the remaining 5 patients were resistant to these combination therapies. On the contrary, in patients with renin independent hypertension, the treatment with furosemide was effective, especially when combined with propranolol, clonidine or other, drugs. Both nifedipine and captopril were useful in the treatment of advanced hypertension irrespective of renin dependency. Hypotensive effects of these antihypertensive drugs were enhanced by the combination with other drugs, especially when nifedipine was administered together with propranolol or clonidine and when captopril was accompanied by furosemide. However, the antihypertensive effect of captopril was found to be attenuated by the addition of indomethacin in a patient with low renin hypertension. These data show that angiotensin II antagonist is useful to predict the effectiveness of antihypertensive drugs in the treatment of advanced or malignant hypertension. Both nifedipine and captopril are very effective irrespective of renin dependency, but it must be noted that the hypotensive effect of captopril is attenuated by the additional administration of nonsteroidal anti-innammatory drugs.
