TREATMENT OF HIGH RENIN REFRACTORY HYPERTENSION IN CHILDREN WITH MINOXIDIL (A NEW HYPERTENSIVE DRUG NOT PREVIOUSLY USED IN CHILDREN)

Abstract

Hypertension developed in a 10 yr. old girl following a renal transplant with blood pressure (BP) between 160/120 and 200/160, and elevated peripheral vein renin (15.2 to 35.5 ng/ml/hr, normal 0.53 ± 0.4). Before transplantation her kidneys had been removed and no stenosis was evident at the site of the anastomosis by angiography. While hypertensive, she developed cardiomegaly and deterioration of renal function [serum creatinine (Cr) from 0.8 to 2.1 mg²]. BP was uncontrollable with daily dosages of Methyldopa 2.5 gm, Hydralazine 300 mg, Guanethidine 200 mg, Propranolol 100 mg, Furosemide 120 mg, and only transient relief was achieved by Diazoxide (300 to 600 mg/day). A transplant nephrectomy was contemplated. Minoxidil given 2.5 mg/6 hrs orally reduced her BP to normal (130/80) within 12 hrs. Other antihypertensives except Propranolol and Furosemide were discontinued. With normalization of BP the heart size decreased and the renal function improved (Cr 0.9 mg%). Five months later on Minoxidil (10 mg/6 hrs) her BP is 130/90, her transplant function is excellent (Cr 0.8 mg%), but the renins remain elevated (13.9 to 24.5). A side effect of generalized hirsutism has occurred. It is felt that high renin refractory systemic hypertension can be controlled by Minoxidil and offers an alternative to transplant nephrectomy.

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