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A randomized, double-blind, placebo-controlled study was set up to study the effects of acute and chronic administration of carvedilol, a vasodilatory beta-blocker in essential hypertension. Acute administration of a single dose of 50 mg of carvedilol reduced systolic and diastolic blood pressure, without inducing reflex tachycardia. Renal blood flow was preserved; accordingly renal vascular resistance was significantly reduced. A significant reduction of glomerular filtration rate and filtration fraction was observed. Plasma renin activity (PRA) and plasma aldosterone were not changed. Chronic carvedilol treatment produced a significant fall in systolic and diastolic office and ambulatory blood pressure, heart rate, cardiac output, PRA and plasma aldosterone. Blood pressure variability was not changed. Renal blood flow, glomerular filtration rate and filtration fraction also remained unchanged; renal vascular resistance decreased significantly. It is concluded that carvedilol possesses definite antihypertensive and renal vasodilating properties, both acutely and after chronic treatment.

The effect of the converting enzyme inhibitor lisinopril on renal and cardiac hemodynamics was studied in patients with moderate to severe primary hypertension, in a multicenter, double-blind, randomized clinical trial comparing the antihypertensive effect of lisinopril (LIS) and nifedipine (NIF). After a 2 week placebo run-in period, 15 patients were randomized in a 2:1 ratio to receive either LIS (20-80 mg q.d., n = 10) or NIF (20-40 mg b.i.d., n = 5). LIS significantly reduced blood pressure (BP) without changing heart rate or cardiac output. LIS significantly increased renal blood flow; glomerular filtration rate (GFR) was not changed. It can be concluded that LIS is an effective antihypertensive agent with a favorable renal hemodynamic profile.