The hemodynamic effects of minoxidil are generally similar to those of hydralazine, with the noteworthy exception that a greater decrease in peripheral vascular resistance and consequently a larger reduction in blood pressure can be achieved with minoxidil. Minoxidil produces no important changes in either renal blood flow or glomerular filtration rate. It has little or no effect on venous capacitance and does not inhibit the reflex activation of the sympathetic nervous system. Orthostasis and other side effects of sympathetic blockade are therefore not a problem. As with hydralazine, there is a significant increase in cardiac output that is secondary to reflex increases in sympathetic activity, hyperrenine-mia, and salt and water retention. These effects can substantially reduce the effectiveness of minoxidil when it is used alone. The addition of a p-blocker and a diuretic to the therapeutic regimen will preserve minoxidil's an-tihypertensive action while attenuating some of the undesirable side effects.
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