Propranolol in the Management of Hypertension in a Long-Term Dialysis Program

IN patients with chronic renal failure requiring maintenance dialysis, hypertension is frequently difficult to control without bilateral nephrectomy. Because of surgical risks in uremic patients, and also because of the complicating postnephrectomy anemias and problems in fluid and electrolyte balance, it is desirable to avoid nephrectomy. This is true particularly in view of the observed occasional improvement in renal function after several months of dialysis. Recently there have been reports on the value of propranolol hydrochloride in controlling severe hypertension in nonuremic patients.¹We are reporting a trial of this drug in patients with uremia. Patients and Methods Six of the 20 patients on the longterm dialysis program have had persistent hypertension, despite therapy with furosemide, methyldopa, hydralazine hydrochloride, and guanethidine sulfate, and rigorous control of sodium intake and weight gain between dialyses. Many were experiencing postural hypotensive effects, drowsiness, and impotence, and were therefore at the limit of