The effects of a combined
therapy with a
calcium channel antagonist and alphabeta-blocker in patients with accelerated-
malignant hypertension on blood pressure and renal function were examined. Thirteen patients presented with the clinical features of
malignant hypertension (diastolic blood pressure >130 mmHg,
retinal damage and progressive
renal failure) at our hospital, over the 3 yr period from 1995 to 1997. These patients were treated with both a
calcium antagonist, 60-80 mg/d dose of long acting
nifedipine, and an alphabeta-blocker, 20 mg/d dose of
arotinolol, for over 12 mo. At admission, the average blood pressure of the patients was 233+/-8/144+/-3 mmHg. The level of serum
creatinine in these patients was 6.2+/-1.0 mg/dl. Intermittent
hemodialysis therapy was introduced in 7 patients. Three days
after treatment, blood pressure decreased to 162+/-4/102+/-4 mmHg. A month later, blood pressure decreased to 148+/-3/89+/-2 mmHg and serum
creatinine levels were 3.6+/-0.4 mg/dl. Renal function in these patients improved, and they completely recovered from renal dysfunction, allowing withdrawal of haemodialysis
therapy. One year later, the blood pressure in all of these patients was well controlled and no further renal deterioration was observed, except in one patient. Despite the reduction in blood pressure, one patient was on
hemodialysis three times a week after 8 mo of treatment. From these finding, it is concluded that combination
therapy with a
calcium antagonist and alphabeta-blocker is effective in both the reduction of highly elevated blood pressure and protection of the kidneys, resulting in amelioration of accelerated-
malignant hypertension.