Haemodynamic Effects of Occlusion of Abdominal Aorta During Nitorgen Mustard Therapy
Authors: J. R. Harries, F. Brown, J. L. Beecher, H. F. Oettgen
Journal: BMJ (1963)

in which the blood-pressure should be lowered to improve prognosis (Turner, 1962; Smirk, 1962).These patients are usually symptomless, so that treatment should be free of side-effects.Many of these patients are treated with a combination of reserpine and a diuretic of the thiazide group.Such a combination is not free from side-effects, and it was thought that the addition of hydrochlorothiazide to the new hypotensive drug methyldopa might lower the blood- pressure to the same extent with less side-effects.A double-blind trial on 18 patients with moderate hyperten- sion comparing methyldopa combined with hydrochloro- thiazide and reserpine with hydrochlorothiazide has not supported this idea.Both combinations satisfactorily reduced the blood-pressure of all patients, but in every case the patient felt better on placebo than on either form of treatment.When comparing the two treatments in the 17 patients who completed the trial, nine preferred the reserpine with hydrochlorothiazide, three methyldopa with hydrochlorothiazide, and five had no preference.Methyldopa is a potent hypotensive agent; the optimum daily dose for any patient can vary between 750 mg. and 3 g. (Irvine et al., 1962).Because of this variable response it was thought necessary to have a preliminary phase to the trial to find the optimum dose of methyldopa with hydrochlorothiazide for each patient.This dose of methyldopa was compared with the maximum satisfactory dose of reserpine (0.5 mg. a day) (Smirk, 1957).The ideal drug for the hypertensive patient without symptoms who needs treatment should be free from side- effects.Methyldopa is an effective hypotensive drug, but often a large number of tablets are needed and minor side- effects are present.A combination of hydrochlorothiazide and methyldopa produces good control of blood-pressure with a reduced.number of tablets.This combination caused significant side-effects in 9 out of 18 patients.The margin of difference between the two regimes of treatment was small, and related only to the incidence and severity of side-effects.The most striking finding in our patients was that they all felt much better on placebo.Neither methyldopa with hydrochlorothiazide nor reserpine with hydrochlorothiazide is ideal treatment for moderate hypertension.Sunumary Eighteen patients were treated in a double-blind trial to compare methyldopa with hydrochlorothiazide and reserpine with hydrochlorothiazide (one patient did not finish the trial).Both combinations satisfactorily reduced blood-pressure; the average falls were 45/23 mm.Hg standing and 32/18 mm.lying with methyldopa and hydrochlorothiazide and 45/25 mm.Hg standing and 34/20 mm.lying with reserpine and hydrochlorothiazide.Nine patients preferred reserpine with hydrochlorothiazide, three methyldopa with hydrochlorothiazide, and five had no preference.All felt much better on placebo.Neither combination is ideal treatment for symptomless patients who require hypotensive drugs.We are grateful to Mrs. J. Johnstone and Miss J. Fairburn, technicians at the hypertension clinic, who took the blood- pressure readings and assisted in other ways during the study.