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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Captopril (Capoten) and minoxidil (Loniten) have recently become generally available for treatment of hypertension, and calcium channel blockers, although not yet officially approved for this indication, clearly have potential as antihypertensive agents. Captopril, the only available inhibitor of angiotensin-converting enzyme, is particularly effective in patients with severe, high-renin hypertension. Minoxidil, a potent direct-acting vasodilator, is particularly effective in severely hypertensive patients with concomitant renal insufficiency. Because serious side effects have been noted with both drugs, their use probably should not be considered until other agents have failed. Of the calcium channel blockers, nifedipine (Procardia) seems to have greatest promise as an antihypertensive agent.
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PMID:Newer antihypertensive agents. 633 40

The systemic, cardiovascular hemodynamic and biochemical interactions between clonidine and minoxidil were studied in ten patients with refractory and/or accelerated hypertension. Clonidine in oral doses of 150 to 900 micrograms/day decreased mean blood pressure (MAP) 18.6 mm Hg (p less than 0.01), average heart rate (HR) 16.4 bpm (p less than 0.01), limb blood flow 1.63 ml/100 g min (p less than 0.05), plasma renin activity (PRA) 1.13 ng/ml/hr (p less than 0.025), and urinary noradrenaline excretion rate 16.45 micrograms/24hr (p less than 0.05). Clonidine increased the preejection period index (PEPI) 12.4 msec ( p less than 0.001), but did not alter cardiac index (CI), total peripheral resistance index (TPRI), limb vascular resistance nor dopamine beta-hydroxylase activity. When minoxidil in oral doses of 5 to 22.5 mg was added, a further decrease in MAP of 24.2 mm Hg (p less than 0.01) was observed; PEPI decreased 20.6 msec (p less than 0.01), limb blood flow decreased 13.2 mm Hg/min 100 g/ml (p less than 0.05), and total peripheral resistance index decreased 13.3 mm Hg/min m2/L (p less than 0.05). Minoxidil increased average heart rate 8.2 bpm (p less than 0.05), PRA 1.68 ng/ml/hr (p less than 0.05) and urinary noradrenaline excretion rate 5.0 micrograms/24 hr (p less than 0.01). Limb blood flow, cardiac index and dopamine beta hydroxylase activity were not significantly altered by minoxidil. Neither clonidine nor minoxidil affected cardiovascular responses to treadmill exercise. We concluded that clonidine is a useful alternative agent to block a minoxidil-induced increase in sympathetic nervous activity.
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PMID:Cardiovascular hemodynamic interactions between clonidine and minoxidil in hypertensive patients. 633 28

Minoxidil, a potent peripheral vasodilator used orally for refractory hypertension, has produced hypertrichosis. To determine the efficacy and safety of 1% or 5% topical minoxidil for the stimulation of scalp hair regrowth, we studied fifteen normotensive patients, five with androgenic alopecia and ten with alopecia areata diagnosed clinically and by biopsy, for 12 months. Three of five patients with androgenic alopecia using 5% minoxidil for 12 months noted hair regrowth, ranging from minimally observable hair to an appreciable restoration of larger, pigmented, terminal hair in one patient. Among the patients with androgenic alopecia, regrowth response corresponded to the serum minoxidil blood levels. None of the patients with alopecia areata receiving either 1% or 5% minoxidil noted hair regrowth despite comparable minoxidil blood levels. Improved local absorption of topical minoxidil solution may promote hair regrowth in androgenic alopecia.
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PMID:Topical minoxidil for hair regrowth. 638 89

Hydralazine, labetalol, methyldopa, minoxidil, prazosin and placebo were compared when added to atenolol 100 mg and bendrofluazide 5 mg daily in hypertensive patients inadequately controlled by the beta-blocker/diuretic combination. Atenolol was withdrawn in those allocated to labetalol and minoxidil was given only to men. The order of acceptability was: placebo, hydralazine, prazosin, methyldopa, minoxidil, labetalol. All the active agents were more effective than placebo. Minoxidil was more effective than the other active drugs, which had similar potency to one another. Hydralazine was the most generally suitable third drug, with prazosin a close second. Minoxidil was effective in the milder hypertensives, but in the present regimen caused fluid retention in those with more severe hypertension. Labetalol probably should be introduced at lower dose (150 mg daily) even as replacement for full doses of a previously administered beta-blocker.
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PMID:The 'third drug' trial: a comparative study of anti-hypertensive agents added to treatment when blood pressure is uncontrolled by a beta-blocker plus thiazide diuretic. 640 Jan 10

Hydralazine, labetalol, methyldopa, minoxidil, prazosin, and placebo were compared when added by random allocation to atenolol 100 mg and bendrofluazide 5 mg daily in a series of 238 hypertensive patients inadequately controlled by the beta blocker-diuretic combination. Atenolol was withdrawn in those allocated to labetalol, and minoxidil was given only to men. The order of acceptability was: placebo, hydralazine, prazosin, methyldopa, minoxidil, labetalol. Minoxidil was more effective than the other active drugs, which had similar potency to one another. All the active agents were more effective than placebo. Hydralazine was the most generally suitable third drug, with prazosin a close second. Minoxidil was especially effective in patients with less severe hypertension but the same regimen caused fluid retention in those with more severe disease. Labetalol should probably be introduced at a low dose (150 mg daily) even when replacing full doses of a previously administered beta blocker.
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PMID:"Third drug" trial: comparative study of antihypertensive agents added to treatment when blood pressure remains uncontrolled by a beta blocker plus thiazide diuretic. 641 9

Sixteen children with renal disease and severe hypertension refractory to other drugs were treated with minoxidil for periods of five days to 77 months. The maximum dose ranged from 0.05 to 1.88 mg/kg/d. With therapy, the mean BP decreased from 158/112 to 133/90. Thirteen children had an antihypertensive response. 2 had progressive rejection of transplanted kidneys, and 1 received a low dose and failed to respond. Complications were hypertrichosis in 14; fluid retention in 4, with congestive heart failure in 1; and decreased renal function in 2. Pericarditis, possibly related to minoxidil, occurred in one child. Minoxidil is a valuable antihypertensive drug in children but should be used with caution.
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PMID:Severe hypertension in children with renal disease: treatment with minoxidil. 686 74

Minoxidil (U-10,858) has been shown in several controlled and blind studies and numerous uncontrolled studies to be a potent peripheral vasodilator for use in the management of sustained, severe, accelerating or malignant hypertension and moderate hypertension inadequately controlled by conventional therapy. Some effect may be seen four hours after oral administration with the peak effect being seen between four and 18 hours. The drug has a plasma disappearance half-life of 4.2 hours despite a duration of action of approximately 24 hours, suggestive of extravascular accumulation. Reported dosages range from 2 mg to 80 mg daily, most patients requiring approximately 20 mg daily. Rapid loading schedules have been studied but are not yet widely used. Frequent adverse effects include sodium retention, tachycardia, EKG changes, and hypertrichosis. Pericardial effusion, altered renal function, diabetes mellitus, and changes in plasma renin, urinary norepinephrine, and aldosterone levels have been reported. Other minor problems have been reported infrequently.
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PMID:Minoxidil. 698 52

The chemistry, pharmacokinetics, mechanism of action, clinical studies, adverse effects, toxicology, indications, contraindications, drug interactions, and dosing of minoxidil, a recently approved antihypertensive agent, are reviewed. Minoxidil is an orally effective vasodilator that selectively relaxes peripheral arteriolar smooth muscle, Reflex tachycardia, renin stimulation, and sodium retention occur when minoxidil is used and so it requires the concomitant use of a diuretic and a sympathoplegic agent, usually a beta blocker. Hirsutism and pericardial effusions are additional adverse effects. Minoxidil is indicated in the management of severe hypertension in patients who do not respond to standard antihypertensive agents. In controlled and unctrolled studies, minoxidil was effective in patients with hypertension secondary to renal or renovascular disease and in patients with essential hypertension. Minoxidil is a potent antihypertensive agent with adverse effects that limit its use to patients resistant or intolerant to other drugs.
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PMID:Evaluation of minoxidil. 699 95

The effects of clonidine and minoxidil on sympathetic nervous activity has been studied in 10 patients with accelerated or resistant hypertension. Clonidine 150 to 900 micrograms/day caused a significant decrease in blood pressure of 18.6 mm Hg, of heart rate 16.4 beats/min, of plasma renin activity 1.13ng/ml h, and of urinary noradrenaline excretion 11.55 micrograms/day, and a significant lengthening of the pre-injection period of 12.4 ms. Minoxidil 5 to 22.5 micrograms/day caused a further significant decrease in blood pressure of 24.2 mm Hg, and significant increases in heart rate 8.2 beats/min, plasma renin activity 1.68 ng/ml h and of urinary noradrenaline excretion 5.0 micrograms/day, and a significant shortening of the pre-ejection period of 20.6 ms. Neither clonidine nor minoxidil altered plasma dopamine beta-hydroxylase activity or the cardiovascular responses to treadmill exercise. It is concluded that clonidine is a useful alternative agent to block a minoxidil-induced increase in sympathetic nervous activity.
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PMID:Effect of minoxidil on sympathetic nervous activity in clonidine-treated hypertensive patients. 703 Jul 51

Minoxidil was used in 25 patients with severe hypertension whose blood pressure (BP) could not be controlled with conventional treatment or who suffered from intolerable side effects during treatment with other drugs. In 6 patients minoxidil was withdrawn after a short time owing to side effects or because hypertension could be controlled by regular dialysis treatment. The remaining 19 patients were treated with minoxidil for 0.5-4.5 years. The hypotensive effect of minoxidil in combination with beta-blockers and diuretics was good or acceptable in all patients. Neither orthostatic hypotension nor development of resistance was observed. Minoxidil was well tolerated in one patient with porphyria and in two patients who have had the hydralazine syndrome. Eighteen patients had kidney failure with elevated serum creatinine. With one exception the uraemia progressed if the serum creatinine level was above 300 mumol/litre at the start of the treatment. All patients tended to develop oedema, but this was controlled by concomitant diuretic therapy. Eighteen patients developed hypertrichosis. No other significant side effects were observed. One patient died and two patients developed pericarditis in the highly uraemic phase in connection with the start of dialysis. Neither the death nor the cases of pericarditis can be attributed to minoxidil. Minoxidil was found to be effective in severe hypertension in connection with advanced renal disease and can be considered as a valuable addition to the established therapeutic arsenal for treatment of severe hypertension.
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PMID:Clinical experience of long-term treatment with minoxidil in severe arterial hypertension. 708 94


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