Minoxidil

Abstract

Now that minoxidil is freely available for general use, we may confidently predict an expanded role for this agent in severe as well as in moderate hypertension. In patients treated by dialysis minoxidil will control refractory hypertension, thus avoiding the need for bilateral nephrectomy. More important numerically, however, will be its use in the large number of patients developing hypotension during or after dialysis but prone to unacceptable degrees of hypertension as plasma volume expands in the interdialytic period. Several investigators have commented on the reduced volume sensitivity with minoxidil, as contrasted to the effects of the sympathetic blocking agents, and have obtained good blood pressure control despite excessive fluid accumulation in the interval between hemodialyses. If these observations can be confirmed on a larger scale, then the absence of hypotension from dialysis ultrafiltration will prove to be a great boon, and minoxidil may well become the drug of choice in the hypertensive dialysis patient. This is particularly important since blood pressure control should be continuous rather than intermittent if the progression of cardiovascular damage is to be arrested.