Moxonidine treatment of hypertensive patients with advanced renal failure.
OBJECTIVE
To compare safety and tolerability of moxonidine versus nitrendipine in hypertensive patients with renal failure. A secondary endpoint was to test whether the sympatholytic drug moxonidine slows decline of renal function when added to standard therapy with an angiotensin-converting enzyme inhibitor or AT(1) receptor antagonist plus loop diuretic.


METHODS
This prospective, randomized, double-blind, multicenter study recruited 177 patients with advanced renal failure receiving antihypertensive standard therapy at outpatient clinics in Germany and Hungary. Following a 2 week run-in, patients were randomized to 24 weeks of add-on treatment with 0.3 mg/day moxonidine or 20 mg/day nitrendipine.


RESULTS
The incidence of pre-defined specific adverse events was 42% in the moxonidine (37/89 patients) and 46% in the nitrendipine group (38/82 patients) in intention-to-treat analysis. Intensity and multiplicity were comparable. The dropout rate due to adverse events was 12.4% in the moxonidine and 9.8% in the nitrendipine group. Creatinine clearance according to Cockcroft and Gault decreased by 0.5 +/- 4.3 ml/min (mean +/- standard deviation) in the moxonidine group and 2.3 +/- 4.0 ml/min in the nitrendipine group. Serum creatinine increased by 12.7 +/- 49.2 micromol/l in the moxonidine group and by 43.4 +/- 71.3 micromol/l in the nitrendipine group. These differences were statistically significant (P < 0.05).


CONCLUSIONS
Add-on treatment with 0.3 mg/day moxonidine in hypertensive patients with renal failure is well tolerated and not inferior to 20 mg/day nitrendipine with respect to the incidence of specific adverse events. The idea of a sympatholytic drug to be renoprotective is appealing but needs further evaluation.
Vonend
Oliver
O
Department of Nephrology of the Ruhr-University Bochum at Marienhospital Herne, Germany.
Marsalek
Parvaneh
P
Russ
Hagen
H
Wulkow
Ralf
R
Oberhauser
Vitus
V
Rump
Lars C
LC
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009568:Nitrendipine / Q000008:administration & dosage / Q000009:adverse effects; D010352:Patient Dropouts; D011446:Prospective Studies; D012720:Severity of Illness Index
D000959:Antihypertensive Agents; D007093:Imidazoles; D009568:Nitrendipine; D003404:Creatinine; C043482:moxonidine