Duration of Anticoagulant Effect in Relation to Urinary Excretion of Dextran Sulphate
Authors: S. M. Jeavons, K. W. Walton, C. R. Ricketts
Journal: BMJ (1956)

For uncomplicated hypertension of Grade 3 or 4 severity, the combination of rauwolfia with a ganglion-blocking agent is the treatment of choice.This may be supplemented by salt restriction, and, if the response is incomplete or delayed, lumbo-dorsal sympathectomy may then be con- sidered.It is said that a previous sympathectomy enhances the effects of hypotensive drugs. VII. ConclusionsHypertensive vascular disease presents in such a great variety of patterns, and runs such an unpredictable course, that the effects of treatment are difficult to assess.Nevertheless, the remedies at present available, if selected judiciously, applied conscientiously, and adjusted carefully to the particular needs of the individual, offer more for hypertensive patients than ever before.The maintenance of the blood pressure within the normal range permits a reversion of the vascular damage in the retinae, heart, and brain, provided renal function is not grossly impaired and massive tissue destruction has not occurred.Early treatment, even in the severe forms of hypertensive disease.should reduce the risk of serious com- plications and be the means of prolonging life.In general, appropriate therapy, which is most often a combination of different remedies, should be determined more by the patient's vascular state than by blood-pressure read- ings.For the most part the retinal picture, taken with the state of the heart and kidneys, determines treatment.Summary A great variety of remedies are available for treatment of hypertensive vascular disease.General measures in- clude: (a) simple psychotherapy; (b) advice regarding a physiological way of life; and (c) instructions regarding weight reduction and restricted Na intake.The detection of a precise aetiological cause, and its prompt surgical removal, can lead to permanent cure.In most cases treatment must be determined by the degree of vascular impairment rather than by blood- pressure readings.All patients showing hypertensive retinopathy should have intensive therapy, also those without serious retinal changes but who have had transient cerebrovascular episodes, attacks of left ventricular failure, or angina.Most patients disabled by severe hypertensive symptoms will also require the more potent hypotensive remedies.Patients who have no symptoms, or only minor ones, and who present no evidence of serious retinal, cerebral, or cardiac damage require advice about their mode of life, and only mild hypotensive agents such as rauwolfia.Rauwolfia potentiates other hypotensive agents.Rauwolfia, with or without " veriloid," and a low-salt diet may keep hypertensive heart failure in check, but more commonly pentolinium and Na restriction will be required.Rauwolfia alone or with veriloid often helps the anginal patient with hypertensive coronary disease.Low-sodium diet combined with veriloid is probably safer than intensive methonium therapy for cerebro- vascular lesions.For uncomplicated Grade 3 or 4 hypertension rauwolfia with pentolinium is the treatment of choice.Preliminary experience suggests that the effective dose of mecamylamine is more readily determined and more constant than that of the methonium compounds.It may therefore ultimately replace pentolinium, but the long-term results are not yet known.In the presence of uraemia all hypotensive drugs are valueless, though in the milder grades of renal impairment hydrallazine (" apresoline ") may prove helpful.For patients incapable of regulating their pentolinium routine, or if the response to the drug is poor, lumbo- dorsal sympathectomy is indicated, provided renal and cardiac functions are reasonably good.