It has been shown that renal hemodynamic changes following the decrease in cardiac output (CO) after therapy with beta-blockers may affect glomerular filtration rate (GFR), therefore limiting the effectiveness of these drugs; obviously more serious effects might be expected in nephropathic patients with previously reduced renal function. Recent clinical studies have demonstrated that nadolol, a non-cardioselective beta-blocker, preserves the renal blood flow (RBF) and the GFR. In this study, the drug was administered alone (80 mg once daily) for 2 months to 9 male renal parenchymal hypertensive patients with normal or moderately reduced renal function. Systemic and renal hemodynamics, plasma volume (PV), plasma renin activity (PRA) and urinary aldosterone excretion (UA) were evaluated before and after treatment. As blood pressure (BP) fell so did the cardiac index (4.27 +/- 1.05 l/min/m2 to 3.14 +/- 0.48 p less than 0.01), while the peripheral resistance index (TPRI) rose slightly (2257 +/- 658 to 2459 +/- 498 p = NS). No change in PV, RBF, GFR and renal vascular resistance was observed. An increasing trend in PRA (0.81 +/- 0.56 to 1.27 +/- 0.95 ng/ml/h) and no change in UA were observed. Our data show that nadolol was both well tolerated and effective in lowering BP, that it caused systemic hemodynamic alterations similar to those described for other beta-blockers, and preserved RBF and GFR also in renal hypertensive patients with reduced non-azotemic renal function.
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