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Nifedipine과 Captopril이 혈액투석중 동반된 심한 고혈압에 미치는 영향 |
홍과표 , 이성숙 , 곽시영 , 최창필 , 박진석 , 박요한 , 이시래 |
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Abstract |
We investigated the antihypertensive effects of sublin- gual nifedipine, the calcium channel blocker, and of captopril, the angiotensin converting enzyme inhibitor, on the patients with moderate to servere hypertension developed during hemodialysis. In the patients to whom nifedipine was given sublin- gually (n=10) the initial blood pressure was 20820/ 118+-16mmHg, plasma renin activity (PRA) was 8.8± 12.3ng/ml/h, and aldosterone was 631±426pg/ml. After sublingual administration of nifedipine the decrease in blood pressure was noted at 5 minutes. The decrease became significant at 15 minutes (p<0.001) in systolic blood pressure (SBP) and at 20 minutes (p<0. 001) indiastolic blood pressure (DBP). The maximal antihypertensive effects were noted at 150 minutes in SBP and at 120 minutes in DBP, and the reductions were 69±17 mmHg and 39±13mmHg, respectively. Captopril was orally given to 6 patients of whom PRA was low in 3 (low-renin group) and normal to high in others (high-renin group). The initial blood pressure was 210+20/123+12 mmHg in high-renin group and 213± 21/117±21 mmHg in low-renin group. 30 minutes after completion of hemodialysis the blood pressure de- creased to 173±15/97±6 mmHg in high-renin group and 207±21/107±12mmHg in low-renin group. Although statistically not significant, the change in blood pressure was more prominent in the former. These results indicate that the antihypertensive effect of sublingual nifedipine is prompt and safe and suggest that it be of effect in the management of severe hyper- tension which develops during hemodialysis. The capto- pril may be used prior to initiation of hemodialysis in the patients with episodes of severe hypertension during hemodialysis, especialy with high renin level but it requires furthr study. |
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