Mitchell H C, Pettinger W A
J Cardiovasc Pharmacol. 1980;2 Suppl 2:S163-72. doi: 10.1097/00005344-198000022-00010.
Renal function was monitored in 20 previously refractory hypertensive patients treated for 2--7 years with minoxidil, sympathetic suppressants, and diuretics. Serum creatinine concentration increased by more than 1 mg/dl in 9 of the 20 patients. In 4 of the 9 patients, renal disease progressed to require hemodialysis. Eleven patients had no progression of renal disease (creatinine increased less than or equal to 1 mg/dl). Three of the 11 had had malignant hypertension with renal failure which was reversed during this triple therapy. Neither the quality of blood pressure control nor the duration of minoxidil therapy correlated with increases in serum creatinine concentration. Plasma norepinephrine levels were higher (p less than 0.01) and plasma renin activity lower (p less than 0.02) in the group with progression of renal disease. Serum creatinine at the time when neuroendocrine studies were done correlated with PNE (r = 0.51, p less than 0.05). Addition of clonidine to this triple regimen in 2 patients with advanced renal disease lowered plasma norepinephrine by 63 and 81%. These findings suggest that the high norepinephrine levels are due to excess release of norepinephrine rather than defective renal elimination of this catecholamine. Whether the elevated plasma norepinephrine contributes to or is a result of the underlying disease is not known.
对20例先前难治性高血压患者的肾功能进行了监测，这些患者用米诺地尔、交感神经抑制剂和利尿剂治疗了2至7年。20例患者中有9例血清肌酐浓度升高超过1mg/dl。在这9例患者中，有4例肾病进展到需要血液透析。11例患者肾病无进展（肌酐升高小于或等于1mg/dl）。11例中有3例曾患有伴有肾衰竭的恶性高血压，在三联疗法期间病情得到逆转。血压控制质量和米诺地尔治疗持续时间均与血清肌酐浓度升高无关。肾病进展组的血浆去甲肾上腺素水平较高（p<0.01），血浆肾素活性较低（p<0.02）。进行神经内分泌研究时的血清肌酐与血浆去甲肾上腺素相关（r = 0.51，p<0.05）。在2例晚期肾病患者的三联疗法中加用可乐定，使血浆去甲肾上腺素降低了63%和81%。这些发现表明，高去甲肾上腺素水平是由于去甲肾上腺素释放过多，而非肾脏对这种儿茶酚胺清除缺陷所致。血浆去甲肾上腺素升高是潜在疾病的原因还是结果尚不清楚。
