Hyperfiltration and Conservation of Renal Function in Hypertensive Nephrosclerosis Patients

Lee, Hing-Chung; Mitchell, Helen C.; Dreal, P Van; Pettinger, William A.

doi:10.1016/0272-6386(93)70076-b

Cited by 5 publications

(4 citation statements)

References 48 publications

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“…My opinion is that this quality of blood pressure control for this time interval caused reversal of arteriolar hypertrophy. This result contrasted with Mitch & Walser’s conclusion that, “renal disease progression once established progresses irrevocably” (36) in such patients .Simultaneous studies (40) reversed the concept that hyper-filtration is the mechanism for progressive loss of kidney function studied in rats (41,42). Minoxidil induced hyperfiltration in hypertensive nephrosclerosis patients while simultaneously improving kidney function over a three year period.…”

Section: Minoxidil and Saving The Kidneys In Refractory Hypertensionmentioning

confidence: 80%

“…Simultaneous studies (40) reversed the concept that hyper-filtration is the mechanism for progressive loss of kidney function studied in rats (41,42). Minoxidil induced hyperfiltration in hypertensive nephrosclerosis patients while simultaneously improving kidney function over a three year period.…”

Section: Minoxidil and Saving The Kidneys In Refractory Hypertensionmentioning

confidence: 99%

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Hypertension's 3 Dilemmas and 3 Solutions: Pharmacology of the Kidney in Hypertension

Pettinger

2017

Journal of Cardiovascular Pharmacology

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SUMMARY The Hypertension Community has three conflicting dilemmas, a goal systolic pressure of 120 mmHg or less (The SPRINT Trials), 40% of our 60,000,000 hypertensives still sustain blood pressures above 140/90 mmHg and our most potent antihypertensive drug minoxidil sits on the side-lines, imprisoned in the FDA’s Black Box Designation. My solutions to these dilemmas are: #1. Review of the facts of our most potent antihypertensive drug minoxidil which is essentially free of toxicity, #2. Treatment focus on the fundamental cause of High Blood Pressure, excess dietary sodium and, #3. Prevention of, and/or reversal of, the fundamental mechanism of worsening hypertension, arteriolar hypertrophy. My focus at U.T. Southwestern in Dallas was on extremely severely hypertensive patients with a quantifiable, measurable complication of high blood pressure, progression of nephrosclerotic damage to kidneys. This model had the greatest likelihood of exposing fundamental dis-regulatory mechanisms in hypertensive patients (which it did) and the potential for study of the most relevant antihypertensive drug interactions to achieve optimal blood pressure control (which it did). By maintaining diastolic pressures at 80 mmHg or less in the first NIH supported, long term randomized clinical trial to save the kidneys, the bases for a fundamental blood pressure support mechanism (arteriolar hypertrophy) was illuminated but not fully described until now. This fundamental hypertensinogenic mechanism results from HBP but with time and severity, becomes its own raison d’être. I am now 84 years of age. As a result of a stroke 20 years ago which caused permanent double vision and because of poor blood pressure control with triple therapy I started using minoxidil 5 mg/day along with atenolol and occasional furosemide. Now, along with some dietary salt restriction, my resting blood pressure is 110/65–125/75 and, in spite of > 30 year history of HBP, I have no retinal arteriolar hypertrophy nor arcus senilis (Dr. Schwartz-U. of Miami) which is almost universally present at this age. YES, prevention of, or reversal of, arteriolar hypertrophy should be a central focus of HBP treatment. I simply wish to share a bit of accumulated wisdom that might be of use to others.

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Section: Minoxidil and Saving The Kidneys In Refractory Hypertensionmentioning

confidence: 80%

Section: Minoxidil and Saving The Kidneys In Refractory Hypertensionmentioning

confidence: 99%

Hypertension's 3 Dilemmas and 3 Solutions: Pharmacology of the Kidney in Hypertension

Pettinger

2017

Journal of Cardiovascular Pharmacology

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“…In another study, improved renal function, reflected by positive slope of the reciprocal of the serum creatinine concentration (1/S Cr ) versus time, was demonstrated in hypertensive nephrosclerotic patients treated with minoxidil (?0.0031) versus Enalapril (?0.0025), while the glomerular filtration rate were increased by 48 % with minoxidil (38 mL/min) versus Enalapril (26 mL/min) [29]. Because minoxidil improved renal function while causing a relative hyperfiltration, the authors concluded that glomerular hyperfiltration is an unlikely mechanism for the progression of hypertensive nephrosclerosis.…”

Section: Case Reportsmentioning

confidence: 97%

Does significant renal ablation truly and invariably lead to hyperfiltration and progressive chronic kidney disease?

Wang

Sam

2016

Clin Exp Nephrol

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It is generally believed that significant renal ablation leads to hyperfiltration and eventually progressively worsening chronic kidney disease. The data behind this belief have not been scrutinized intensively. More importantly, the above belief leads many physicians to manage patients differently than they otherwise would manage. Here, we examine the data behind whether hyperfiltration occurs when patients lose kidney mass (by excision or by disease) and whether the hyperfiltration is uniformly injurious.

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“…Minoxidil is a potent vasodilator that has been shown to be effective for the most refractory hypertension, such as that seen with advanced CRF [7] . Although it is considered a safe and benefi cial drug for patients with CRF minoxidil has been shown to cause a relative hyperfi ltration in relation to other antihypertensives [8] . After a patient of ours developed an increase in proteinuria after the addition of minoxidil to an ACEI and an ARB, we worried that the hyperfi ltration resulting from the minoxidil might be a deleterious effect.…”

Section: Introductionmentioning

confidence: 99%

Does the Hyperfiltration of Minoxidil Result in Increased Proteinuria and Loss of Renoprotection Conferred by Angiotensin Inhibition?

Diskin

Stokes²,

Dansby³

et al. 2006

Kidney Blood Press Res

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The objective of the present study was to retrospectively examine whether the addition of minoxidil to patients who were already treated with maximum doses of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers but who had not achieved target blood pressures, has any detrimental effect on proteinuria or renal function or whether its effect on blood pressure prove salutary. The clinical records of the patients seen at the Hypertension, Nephrology, Dialysis and Transplantation Clinic from June 1982 through May 2005 were reviewed to identify 54 patients (78% men, 82% African-American) who had taken minoxidil (with and without angiotensin inhibition and blockade) and who had documented 24-hour urines for creatinine clearance and quantification of proteinuria before the initiation of minoxidil and after the blood pressure had stabilized on its final dose. The study was done at the Hypertension, Nephrology, Dialysis and Transplantation Clinic, the regional referral center for renal problems in eastern Alabama, USA. Minoxidil, whether alone or in combination with maximum doses of ACEIs and ARBs, was very successful in reduction of mean arterial pressure, but there was a tendency towards an increase in proteinuria. When minoxidil was given alone, patients demonstrated a trend towards reduction of proteinuria associated with blood pressure reduction; however, when minoxidil was added after the maximal doses of ACEIs and ARBs had been reached there was a significant increase in proteinuria (p = 0.017) on paired comparison in the same patients whose proteinuria had already demonstrated a significant decrease (p = 0.02) on the ACEI and ARB alone despite further significant reduction of blood pressure with the minoxidil (p = 0.003). Renal function deterioration to end stage renal disease correlated with increase in proteinuria (p = 0.03). We conclude that minoxidil was very effective in lowering systemic blood pressure but when given to patients already on maximum doses of ACEI and ARBs, there was an increase in proteinuria which could be interpreted as a detrimental effect having in mind that the blood pressure was significantly lowered.

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Hyperfiltration and Conservation of Renal Function in Hypertensive Nephrosclerosis Patients

Cited by 5 publications

References 48 publications

Hypertension's 3 Dilemmas and 3 Solutions: Pharmacology of the Kidney in Hypertension

Hypertension's 3 Dilemmas and 3 Solutions: Pharmacology of the Kidney in Hypertension

Does significant renal ablation truly and invariably lead to hyperfiltration and progressive chronic kidney disease?

Does the Hyperfiltration of Minoxidil Result in Increased Proteinuria and Loss of Renoprotection Conferred by Angiotensin Inhibition?

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