Chronic Hemodynamic Effects of Propranolol Treatment in Dialysis-Refractory Hypertension

Abstract

The hemodynamic mechanism of the hypotensive effect of propranolol was studied by quantitative radiocardiography in 8 patients with dialysis-resistant hypertension. Propranolol treatment brought about a decrease in mean arterial pressure and peripheral vascular resistances. The cardiac index was slightly reduced only in the early stage of the treatment. No significant difference was found between patients on treatments lasting longer than 3 months and patients with dialysis-controlled hypertension. The results show that propranolol can be used safely as the sole antihypertensive agent in patients with dialysis-resistant hypertension.

Massive propranolol metabolite retention during maintenance hemodialysis

“…1, 6,II,20 The avid cumulation of 4-hydroxypropranolol glucuronide, propranolol glucuronide, and Propranolol metabolite cumulation in uremia 453 naphthoxylactic acid in uremic patients is not surprising because these metabolites are eliminated only by renal mechanisms and their renal clearance is half of the glomerular filtration rate. 1: [3][4][5][6][7][8][9][10][11][12][13][14][15] It is not surprising that 4-hydroxypropranolol and propranolol kinetics are relatively unaffected by severe renal disease, because the clearance of both is mainly due to metabolism. 9,…”

“…Propranolol has gained widespread acceptance in patients with renal failure and poorly controlled hypertension. 2,7 Problems associated with this therapy have included poor compliance," deterioration in residual renal function, t9 and spurious hyperbilirubinemia.I'' To our knowledge no studies have been performed to assess whether the known side effects of pro- pranolol are more frequent in uremic patients than in patients with normal renal function, Kinetic studies of propranolol in uremic patients have demonstrated a relatively normal plasma half-life (t1Jz), normal binding to plasma proteins, somewhat decreased plasma clearance, and little removal by dialysis, 1,6,11,20 Retention of unspecified metabolites has, however, been indicated, 11,20 In the only studies of major metabolites in renal failure subjects, plasma 4-hydroxypropranolol levels were normal!' and naphthoxylactic acid levels were elevated.…”

Efectos del prazosin sobre el control de la presión arterial en hipertensos sometidos a diálisis

“…Se considera que los mecanismos que causan hiper tensión son acumulación excesiva de sodio y agua, a la que pueden corresponder 70 por ciento de los casos de hipertensión (5), y se supone que en un pequeño porcentaje de los pacientes hay hipertensión por aumento de la renina (6). Este último grupo es el de trata miento más difícil, y se han utilizado con buenos resultados: nefrectomía (6, 7), propra nolol (8,9), hemodiafiltración (5), y saralasina (10). Con el uso de minoxidil ha dismi nuido la necesidad de nefrectomía en esta población.…”

“…La hidralazina es un vasodilatador eficaz, pero a menudo se acompaña de cefalalgia y taquicardia en las dosis necesarias para controlar la presión arterial. El propranolol tiene eficacia máxima cuando se emplea con hidralazina, o en los escasos pacientes de hipertensión hiperreninémica comprobada; no obstante (8,9) es posible agravar con él la insuficiencia cardiaca congestiva en esta pobla ción, aunque datos recientes parecen sugerir que no hay efectos perjudiciales sobre el gasto cardiaco con la administración a largo plazo (8). EÍ prazosin tiene la ventaja de ser un agente selectivo postsináptico de bloqueo beta, y pueden ajustarse fácilmente las dosis hasta niveles altos, lo cual permite controlar la presión arterial en una gran diversidad de pacientes (13).…”

Effect of Chronic Propranolol Treatment on Bone Changes of Secondary Hyperparathyroidism in Dialysis Patients

“…The two groups were well matched for age, sex, duration of renal failure and dialysis treatment, dialysis schedule, residual renal function, use of aluminium hydroxide, heparin, vitamin D 3 metabolites and cimetidine; no patient had undergone parathyroidec tomy or bilateral nephrectomy. In patients of group A propranolol compliance was assessed during the first two treatment years by measuring the blood drug levels [5], thereafter by monitoring blood pressure and pulse rate. score modified, graded 0-10) [6] was almost the same in the two groups (7 ± 3 vs. 7 ± 3); serum-COOH terminal i-PTH fragment (24.8rt 10.8 vs. 22.1 ± 3 .7 mU/ml) and ionised calcium (1.70±0.08 vs. 1.75 ±0.12 mA//I) were also similar.…”