Control of blood pressure and prevention of end-organ damage in patients with accelerated hypertension by combination with arotinolol and extended release nifedipine

In patients with accelerated (malignant) hypertension, end-organ damage is the determinant factor for prognosis. Although recent advances in antihyper tensive therapy have improved the outcome of patients with accelerated hype rtension, the effectiveness of antihypertensive therapy still remains less convinced. In this study, we followed 13 patients clinically diagnosed with accelerated hypertension (defined as diastolic blood pressure > 130 mmHg, retinopathy with K-W IV and accelerated renal impairment) for 3 Lr. One pat ient died due to acute myocardial infarction arising from poor compliance w ith antihypertensive therapy. One patient was maintained on hemodialysis fo r 3 yr. One patient was introduced for continuous ambulatory peritoneal dia lysis (CAPD) for a year and then lived without dialysis therapy. The remain ing 10 patients were followed for 3 yr. All patients were initially treated with intravenous administration of calcium antagonist for reduction of blo od pressure, followed by hemodialysis therapy if needed. After stabilizatio n of blood pressure, combination therapy with extended release nifedipine(4 0 to 80 mg daily) and arotinolol (20 mg daily) was started. The targets for blood pressure control were a systolic pressure of 135 mmHg and a diastoli c pressure of 80 mmHg. If blood pressure control was unsatisfactory, guanab enz (2 to 4 mg before bedtime), a central acting drug, was added. At presen tation, the mean diastolic blood pressure (mDBP) among the 10 remaining pat ients was 134 +/- 2 mmHg, the mean serum creatinine (mScr) was 4.5 +/- 0.7 mg/dl and the left ventricular mass index (LVMi) as measured tay echocardio graphy was 150 +/- 9 g/m(2). At 1 yr, the mDBP was reduced to 90 +/- 3 mmHg , the mScr to 2.9 +/- 0.9 mg/dl and the LVMi to 140 +/- 9 g/m(2). At 3 yr, the mDBP was stabilized at 79 +/- 3 mmHg, the mScr maintained at 2.2 +/- 0. 4 mg/dl, and the LVMi reduced to 128 +/- 9 g/m(2). These results indicate t hat appropriate blood pressure control is important for improvement of rena l impairment and cardiac damage in patients with accelerated hypertension. Moreover, combination therapy with arotinolol and extended release nifedipi ne may be beneficial for this purpose. (Hypertens Res 2000; 23: 159-166).