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Moxonidine Normalizes Sympathetic Hyperactivity in Patients with Eprosartan-Treated Chronic Renal Failure

Jutta Neumann^*, Gerry Ligtenberg^*, Liam Oey, Hein A. Koomans^* and Peter J. Blankestijn^*

Departments of *Nephrology and Clinical Neurophysiology, University Medical Center, Utrecht, the Netherlands.

Correspondence to Dr. Peter J. Blankestijn, Department of Nephrology and Hypertension, Room F03.226, University Medical Center, PO Box 85500, 3508 GA Utrecht, The Netherlands. Phone + 31-30-2507336; Fax: + 31-30-2543492; E-mail: p.j.blankestijn{at}azu.nl

Enalapril and losartan reduce but not normalize sympathetic hyperactivity in patients with hypertensive chronic renal failure (CRF). This study assessed the effect of chronic eprosartan on BP and sympathetic activity, and assessed the effect of moxonidine during chronic eprosartan treatment. In 11 stable patients with CRF (creatinine clearance 47 ± 10 ml/min), muscle sympathetic nerve activity (MSNA; peroneal nerve), BP, and baroreceptor sensitivity were measured in the absence of antihypertensive drugs (except diuretics) during chronic eprosartan therapy (600 mg for 6 wk) and in 9 patients after moxonidine (0.2 mg for 6 wk) was added. Normovolemia was controlled by diuretics and confirmed by extracellular fluid volume measurements. BP, heart rate, and MSNA were higher in patients than in 22 controls. During eprosartan therapy, mean arterial pressure (111 ± 9 to 98 ± 7 mmHg, P < 0.001), heart rate (71 ± 10 to 65 ± 8 bpm, P < 0.001), and MSNA (35 ± 10 to 27 ± 8 bursts/min, P < 0.001) decreased. After the addition of moxonidine (n = 9), a further reduction of mean arterial pressure to 89 ± 7 mmHg (P < 0.05) and of MSNA to 20 ± 10 bursts/min (P < 0.05) occurred. Sympathetic activity in patients with CRF can be normalized, and angiotensin II–independent sympathetic hyperactivity contributes to the pathogenesis of renal hypertension. Sympathetic hyperactivity is associated with poor cardiovascular outcomes, implying that reduction might be beneficial to the patients. The addition of moxonidine to angiotensin II antagonist treatment might be appropriate.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673