Combined Therapy with Vasodilator Drugs and Beta-Adrenergic Blockade in Hypertension

The hypotensive efficacies of two vasodilators, hydralazine and minoxidil, were assessed as these drugs were used individually in combination with beta-adrenergic blockade and diuretics in 11 hypertensive patients in whom elevated blood pressure had not been adequately controlled previously by other antihypertensive therapy. Control supine blood pressure fell from 191/128 mm Hg on propranolol and hydrochlorothiazide to 169/108 mm Hg on hydralazine, with a significantly greater reduction to 142/92 mm Hg on minoxidil. Although sodium retention and tachycardia were controlled by the use of concomitant diuretics and beta-blockade, an increment in each of these drugs was occasionally required to prevent these complications. Renal function was changed little with the decrease in blood pressure. Plasma renin increased from a standing control of 14.5 mµg/ml/hr to 35.9 and 31.1 mµg/ml/hr, respectively, on hydralazine and minoxidil. These data suggest the role of vasodilators used in combination with beta-blockers and diuretics and indicate the greater therapeutic efficacy of minoxidil.