Moxonidine treatment of hypertensive patients with advanced renal failure
Abstract
OBJECTIVES: 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. DESIGN: 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). CONCLUSION: 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.
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In patients with chronic renal failure, moxonidine minimizes progression of renal disease compared with nitrendipine, an effect not explained by the small falls in blood pressure.
“and in another study in patients with chronic renal failure106, to minimize progression of renal disease compared with a comparator drug, nitrendipine, an effect not explained by the small falls in blood pressure.”
From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [106]
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Central sympatholytic drugs for the treatment of hypertension
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Beta-blockers and chronic kidney disease: a literature review
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Niereninsuffizienz und kardiovaskuläre Erkrankungen
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Self-citationAntihypertensive therapy in chronic renal disease
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Arterielle Hypertonie als Progressionsfaktor der chronischen Niereninsuffizienz
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Novel Approaches in Hypertension Treatment - Modulation of the Sympathetic Overactivity
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Renal Denervation: Physiology, Scope, and Current Evidence
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Renal Denervation for Chronic Kidney Disease
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Nolde, J. M., Kiuchi, M. G., Carnagarin, R., Ward, N. C., Wanten, M., Böhm, M., Mahfoud, F., Schmieder, R. E., Narkiewicz, K., & Schlaich, M. P. (2025) · Journal of Hypertension · doi:10.1097/hjh.0000000000004219
- Authors
- Vonend, O., Marsalek, P., Russ, H., Wulkow, R., Oberhauser, V., & Rump, L. C.
- Affiliations
- Universitätsklinik Marien Hospital Herne (DE)
- Eli Lilly (Germany) (DE)
- Corresponding author
- Rump, Lars C
- Venue
- Journal of Hypertension
- Published
- 2003-09
- Volume
- 21
- Issue
- 9
- Pages
- 1709-1717
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2051135596
- Cited by
- 91
- References
- 32
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 6 · 2014: 6 · 2013: 6 · 2012: 6
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- moxonidine, nitrendipine, hypertension, renal failure, advanced chronic kidney disease, add-on antihypertensive therapy, renal protection, sympatholytic agents, adverse events, drug safety and tolerability, creatinine clearance, ACE inhibitors, AT1 receptor antagonists, loop diuretics
- MeSH terms
- Adult, Aged, Antihypertensive Agents, Blood Pressure, Creatinine, Female, Humans, Hypertension, Renal, Imidazoles, Kidney Failure, Chronic, Male, Middle Aged, Nitrendipine, Patient Dropouts, Prospective Studies, Severity of Illness Index, Incidence, Disease Progression
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