Augmented antihypertensive effect of a fixed combination formula of candesartan and hydrochlorothiazide combined with furosemide in a patient on peritoneal dialysis

Abstract

A 38-year-old female patient on peritoneal dialysis (PD) due to type 1 diabetic nephropathy with a well-preserved residual renal function did not respond well to the conventional antihypertensive therapy consisting of candesartan, furosemide, and bunazosin. Switching candesartan for a fixed combination formula of candesartan plus hydrochlorothiazide (HCTZ) while the rest of the other two agents remained unchanged led to the remarkable reduction in both systolic and diastolic blood pressure (BP) without significant changes in the cardiothoracic ratio (CTR), body weight (BW), and residual renal function. This case suggests that when used in combination, diuretics acting on different functional segment of the nephron hold greater potential for enhanced antihypertensive effect, especially in patients on PD whose residual renal function is well preserved. A small dose of HCTZ with an angiotensin II receptor blocker (ARB) may partially explain the therapeutic benefit of this combination therapy in terms of a reliable hypotensive effect, a better adherence, and fewer side effects.

An association of losartan-hydrochlorothiazide, but not losartan-furosemide, completely arrests progressive injury in the remnant kidney

“…Thiazides were shown to lower blood pressure after having promoted slight or no natriuresis (14,26). In addition, TTLD have been reported to exert antihypertensive effects in situations in which significant natriuresis is not possible, such as in subjects with extremely low GFR and even in patients on dialysis (4,10,30). These effects may result from renal and systemic vasodilatation owing to a direct relaxing action on vascular smooth muscle cells (7,8,36,50).…”

Thiazide Diuretics as Chronic Antihypertensive Therapy in Patients with Severe Renal Disease—Is There a Role in the Absence of Diuresis?

“…Kuriyama et al published a case report concerning a 38-year-old female with chronic kidney disease (CrCl 4 mL/min) on peritoneal dialysis. 17 The patient's BP was 160/90 mm Hg despite treatment with furosemide 160 mg, candesartan 8 mg, and bunazosin 3 mg. Several weeks after the addition of hydrochlorothiazide 6.25 mg daily, the BP decreased to 120/80 mm Hg. Sodium balance was not reported, but urine output increased from approximately 1700 mL/day to 2000 mL/day.…”