Long-term treatment with minoxidil in patients with severe renal failure

Clinical trials have confirmed the effectiveness of minoxidil as an antihypertensive drug in patients with normal or mildly decreased renal function. In previous studies the number of patients with severe renal failure has been small or the duration of follow-up not long. We have treated 58 patients, most of them on maintenance hemodialysis, with minoxidil for refractory hypertension. In most patients treatment of hypertension was reduced to two drugs plus minoxidil, and blood pressure decreased significantly from 205/120 ± 10/5 to 150/80 ± 5/5 mm Hg (p < 0.001) without evidence of orthostatic hypotension, and independent of the degree of renal failure. Retinopathy, when present, improved in all patients. In 5 of 11 patients with malignant hypertension, renal function improved enough so as to make maintenance dialysis unnecessary. The most common side effects were hypertrichosis and weight gain, while drowsiness and orthostatic hypotension were infrequent. Asymptomatic and uncomplicated pericardial effusions occurred in 6 patients, none of whom required discontinuation of minoxidil. Long-term minoxidil therapy is highly effective in the management of patients with refractory hypertension and advanced renal failure. Our results also suggest that the indications for minoxidil therapy may be broader than initially thought.