Letter: Beta-adrenergic blocking agents in patients with renal failure.

SIR,-Drs. Priscilla Kincaid-Smith and A. S. P. Hua are disturbed (24 August, p. 520) by our suggestion that beta-adrenergic blocking agents should not be used in patients with moderately severe renal failure (27 April, p. 193). They refer to a previous publication' to show that temporary deterioration in renal function in such patients may occur with the introduction of any hypotensive drug. Their evidence appears to be based on experience with one patient with malignant hypertension who was given 6 different drugs, and is not relevant to the cases described by us. We refer Drs. Kincaid-Smith and Hua to our paper, where they will find that the maximum change in diastolic blood pressure in any of the three cases was 10 mm Hg during the period that renal function deteriorated. Their comments do not shed any light on the mechanism of the events we described. Drs. Kincaid-Smith and Hua will no doubt agree that renal function should be monitored during the course of therapy with hypotensive drugs in patients with renal failure. Our exoerience leads us to suggest that this may be especially important when beta-blocking drugs are prescribed and needs to be emphasized now that these agents are being so forcefully promoted in general practice.-We are, etc., DAVID J. WARREN C. P. SWAINSON N. WRIGHT Medical Renal Unit, Department of Medicine, Royal Infirmary, Edinburgh