1999 Volume 22 Issue 2 Pages 75-80
The effects of a combined therapy with a calcium channel antagonist and αβ-blocker in patients with accelerated-malignant hypertension on blood pressure and renal function were examined. Thirteen patients presented with the clinical features of malignant hypertension (diastolic blood pressure >130 mmHg, retinal damage and progressive renal failure) at our hospital, over the 3 yr period from 1995 to 1997. These patients were treated with both a calcium antagonist, 60-80mg/d dose of long acting nifedipine, and an αβ-blocker, 20mg/d dose of arotinolol, for over 12 mo. At admission, the average blood pressure of the patients was 233±8/144±3mmHg. The level of serum creatinine in these patients was 6.2±1.0mg/dl. Intermittent hemodialysis therapy was introduced in 7 patients. Three days after treatment, blood pressure decreased to 162±4/102±4mmHg. A month later, blood pressure decreased to 148±3/89±2mmHg and serum creatinine levels were 3.6±0.4mg/dl. Renal function in these patients improved, and they completely recovered from renal dysfunction, allowing withdrawal of haemodialysis therapy. One year later, the blood pressure in all of these patients was well controlled and no further renal deterioration was observed, except in one patient. Despite the reduction in blood pressure, one patient was on hemodialysis three times a week after 8 mo of treatment. From these finding, it is concluded that combination therapy with a calcium antagonist and αβ-blocker is effective in both the reduction of highly elevated blood pressure and protection of the kidneys, resulting in amelioration of accelerated-malignant hypertension. (Hypertens Res 1999; 22: 75-80)
