Antihypertensive Treatment in Renal Failure

  • Francois C. Reubi
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 35)


Renal failure may alter the disposition of antihypertensive drugs. The half-life of methyldopa, guanethidine, clonidine captopril and the lipid-insoluble beta blockers may be prolonged. However, the best guide to adequate dosage is the blood pressure response. Furosemide has definite advantages over current thiazid diuretics. Potassium-sparing agents may cause hyperkalemia and should be avoided.

The effects of antihypertensive drugs on renal function vary with time. The initial fall in GFR, responsible for a transient rise in serum creatinine, is followed by a progressive readjustment towards pretreatment values. After years of sustained treatment the drug-specific effects have become negligible, and effective control of hypertension often produces stabilization or improvement of renal function.

Drug combinations including furosemide, a beta blocker and a vasodilator, are generally adequate for long-term treatment. For initiating therapy preference may be given to agents which do not depress markedly GFR. In emergency situations any potent drug may be given. If necessary, transient uremia should be treated by hemodialysis.


Glomerular Filtration Rate Essential Hypertension Antihypertensive Drug Sodium Nitroprusside Blood Pressure Response 
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© Martinus Nijhoff Publishing, Boston/The Hague/Dordrecht/Lancaster 1984

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  • Francois C. Reubi

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