Minoxidil — An Alternative to Nephrectomy for Refractory Hypertension

Eleven patients with malignant or accelerated hypertension refractory to conventional drugs were treated with minoxidil as the primary antihypertensive agent. Seven had advanced renal disease and all were candidates, by conventional criteria for nephrectomy to control blood pressure. The blood pressure was reduced to or near normal levels in all patients, with remarkably few side effects and was well controlled in supine and standing positions. Initiation and maintenance of therapy with minoxidil required meticulous adjustment of diuretic agents to control fluid retention and of propranolol to control reflex cardiac stimulation. The cardiac status improved in all patients treated for more than two months, with reversal of myocardial ischemia and hypertrophy in some. Because of few drug-related symptoms patient acceptance was excellent. Seven patients remain on minoxidil therapy at present. The use of minoxidil in managing hypertensive patients should be carefully weighed against the more heroic alternative nephrectomy and its consequences. (N Engl J Med 289:167–173, 1973)