Die Wirkung langdauernder Guanethidin-Verabreichung auf die Nierenfunktion von Hochdruckkranken

Long-term effects of captopril on renal function in hypertensive patients

The effect of captopril up to 450 mg/day on blood pressure and renal function were investigated during sustained treatment of 10 patients whose severe hypertension had not responded to previous therapy. All the patients were kept on diuretics and most of them on beta-blockers, too. A control determination of glomerular filtration rate (GFR) and para-aminohippuric acid clearance (CPAH) was performed during the prior treatment. The effect of the addition (or substitution) of captopril were assessed after an average of 25 days (short-term) and 26 weeks (long-term). Short-term treatment produced a 15.5% decrease in mean blood pressure and interindividually variable effects on renal function. On average GFR was somewhat lower and CPAH slightly higher than the control values (not significant). This pattern is quite similar to the effects of most other antihypertensive drugs. On long-term therapy GFR rose by a mean of 9% (NS) and CPAH by 17% (p less than 0.02). However, in a patient who developed a captopril-induced nephrotic syndrome, GFR dropped to 56% and CPAH to 50% of the control values. In another patient a transient rise in serum creatinine accompanied a severe drug reaction.

Hypotensive and Renal Effects of Diazoxide, a Sodium-Retaining Benzothiadiazine Compound

Diazoxide, a new compound of the benzo-thiadiazine group, has been shown to decrease both systolic and diastolic arterial pressure in mild or moderate hypertensive patients, even though it lacks the saluretic properties characteristic of the other known compounds of the group.

Instead of promoting sodium excretion, diazoxide appears to be a powerful sodium- and chloride-retaining agent, its prolonged use leading to important increases in plasma volume and body weight, and probably to some redistribution between extracellular and intracellular fluid. Glomerular filtration rate and renal plasma flow are often increased during treatment with the drug.

Although diazoxide was in several respects a useful hypotensive agent, at least in hypertensive patients without heart failure, it may share with other benzothiadiazine compounds some pancreatic toxicity, a side effect that should be carefully considered during benzothiadiazine treatment.