Rapid control of severe hypertension with minoxidil.

We studied nine symptomatic patients whose diastolic BP exceeded 120 mm Hg two hours after receiving a combination of 40 mg of oral propranolol hydrochloride and 40 mg of oral furosemide. Systemic and pulmonary hemodynamics were measured before and after a 20-mg loading dose of oral minoxidil. A booster dosage of 5 to 20 mg of minoxidil was given at four hours if the diastolic BP exceeded 100 mm Hg. There was a progressive and significant reduction of systemic vascular resistance and systolic diastolic BP during the period of hemodynamic monitoring. The decrease in systemic vascular resistance occurred without notable change in cardiac output or pulmonary wedge pressure. The results indicate that an orally administered regimen of propranolol, furosemide, and loading-booster doses of minoxidil produces prompt, progressive, and sustained BP reduction due to vasodilation in patients with severe hypertension who require prompt (but not immediate) BP control.