Conservative management of neonatal renal artery embolism

Renal artery thrombosis or embolism associated with the use of an umbilical arterial catheter can cause renin-dependent hypertension in the neonate. The tip of the catheter should therefore be kept well below the origin of the renal arteries and the infant's blood pressure monitored. Moreover, since the pressor hypertension may be transient and kidney function may return, a period of medical management should be attempted before proceeding to nephrectomy.

Current status of treatment of severe hypertension

Drug fashions have changed and older drugs have given place to others with less side effects. Drugs and combinations of drugs administered to 100 patients currently under treatment at a clinic for severe hypertensives are listed. The most popular drugs were thiazide diuretics, methyldopa, beta-adrenergic blocking drugs, clinidine and hydrallazine. A thiazide diuretic was a constant member of the drug combinations. About 60% of patients achieved "good" blood pressure control (diastolic blood pressure less than or equal to 100 mm Hg), 30% "fair" (diastolic blood pressure=100 to 110 mm Hg) and 10+ "poor" (diastolic blood pressure greater than 110 mm Hg). Similar proportions were in "good", "fair" and "poor" general health. The best prospect for improved management of hypertension probably lies in earlier treatment with current drug combinations.

Fetal outcome in trial of antihypertensive treatment in pregnancy

242 women completed a controlled trial of methyldopa ('Aldomet') for moderate hypertension in pregnancy. Active treatment was associated with a significantly improved fetal outcome, due in part to a reduced number of mid-pregnancy abortions. There were 9 pregnancy losses in the control group, which included 4 mid-pregnancy abortions, and 1 fetal loss in the treated group. The birthweight and maturity of viable infants were similar in treated and control groups, and a detailed multivariate analysis confirmed that hypotensive treatment had no effect on fetal growth in utero. The better outcome associated with treatment was not due to the prevention of pre-eclampsia, and may be partly due to a direct or indirect effect of methyldopa on uterine activity. Methyldopa is safe to use for the treatment of hypertension in pregnancy in the context of close medical and obstetric supervision.

Colitis and hepatitis caused by methyldopa

Acute, severe colitis and hepatitis developed in a 55-year-old man on two occasions in relation to administration of methyldopa. He also had fever, skin rash, and eosinophilia, suggesting drug allergy. All symptoms and signs remitted after he stopped taking the drug. It appears that this agent is capable of producing acute colitis as well as the previously recognized hepatitis.

Blood pressure in the elderly

The distribution of blood pressure levels in elderly patients is described and the evidence that higher levels are associated with morbidity at this age is reviewed. In the absence of definitive evidence about the results of treating hypertension in the elderly, the physiological factors that have to be taken into account are surveyed with particular reference to aggravating cerebral ischaemia.More potent hypotensive agents should be avoided in older patients and in practice the decision on whether to treat may depend more on the clinical context than on the level of the blood pressure itself.

Recovery from malignant hypertension with anuria after prolonged hemodialysis

A 29-year-old black woman with malignant hypertension and anuria was treated with hemodialysis and antihypertensive drugs. Her renal function improved and her creatinine clearance was 28 ml/min after 4 1/2 months of treatment. Similar cases in the literature are reviewed.

[First experiences with BS 100-141, a new antihypertensive substance]

The administration of a new guanidine derivate, BS 100-141, to 20 patients resulted in a statistically highly significant reduction of blood pressure. A comparative clinical trial of BS 100-141 and alpha-methyl-DOPA showed BS 100-141 to be more efficient in lowering the arterial pressure than alpha-methyl-DOPA, especially when the drug was used in the second period of treatment. In the majority of the patients treated with BS 100-141 a slight increase in blood glucose concentration, not exceeding the upper limits of normal values, was found.

Centrally acting alpha-adrenoceptor agonists in hypertension: mechanisms and their role in therapy

Experimental work in animals has shown that both methyldopa and clonidine lower the blood pressure predominantly by an action on the central nervous system. This action is due to alpha-adrenoceptor stimulation by clonidine and by alpha-methyl-noradrenaline. The evidence for a central site of action for these drugs in man is indirect but persuasive. Both drugs lower blood pressure and heart rate without causing much postural or exercise hypetension. Sympathetic responses like the overshoot of pressure following Valsalva's manoeuvre are reduced but not abolished. Failure of ejaculation in the male is much less common than with drugs that are known to blockade sympathetic adrenergic neurones in the periphery.

Renin unresponsiveness and the effects of oxprenolol, methyldopa and spironolactone in pateints with essential hypertension

Plasma renin activity (PRA), supine, erect and post-frusemide (1 mg/kg IV) was studied in 51 patients with previously untreated essential hypertension and their age- and sex-matched normotensive controls. Supine PRA, and the rise in PRA in response to the erect posture and frusemide, were significantly less in hypertensives compared to controls. When the hypertensives were arbitrarily divided into lower, mid, and upper subgroups according to supine PRA, the renin responsiveness was similar in each subgroup but significantly less in hypertensives compared to controls, subdivided in the same way. This does not support the existence of a separate "low renin" subgroup. The low supine PRA and reduced response to stimulation appears to be a feature of patients with essential hypertension. Thirty-nine of these hypertensives entered a double-blind cross-over drug trial of oxprenolol, methyldopa and spironolactone. All three drugs were equally effective in lowering the systolic and diastolic blood pressures in all three renin subgroups. Spironolactone caused a greater fall in systolic pressure in the lower renin group than in the other groups. Oxprenolol was the best tolerated drug, with only 5% of patients withdrawing due to side-effects compared to 13% on spironolacone and 29% on methyldopa.

A nurse clinician's role in the management of hypertension

The nurse has assumed more responsibility for patients with hypertension, not only in their education, but also in their follow-up. In this study the physician was aware of each patient's progress through conference with the nurse clinician. In addition, the nurse clinician consulted the physician about any problems or questions that arose. The nurse also served an educational role by informing patients about their disease and the side effects of the medications being used in their therapy. Since the physician was aware of the progress of these patients, his time was freed for other purposes. The nurse clinician's role in the management of hypertension was beneficial not only to the patient, but also to the physician.

Labetalol in long-term treatment of hypertension

1 Labetalol, a beta- and alpha-adrenoreceptor-blocking drug, has been used in the treatment of hypertension in a total of 32 patients for over 4.5 yr, 14 patients for 3 yr or more. 2 Labetalol seems to have a similarly potency of methyldopa and the adrenergic neurone-blocking drugs. 3 Postural hypotension was only observed at doses over 2 g/d. It was the reason for stopping treatment in two patients. 4 Dosage varied; average 889 mg/d, range 75-3,200 mg. Tolerance did not develop. 5 Side-effects led to drug withdrawal in four patients

Rauwolfia derivatives and breast cancer

During the course of a collaborative study initiated in investigate the relationship of breast cancer and the use of hormones, it was possible to study the possible relationship of rauwolfia derivatives, mainly reserpine, to breast cancer. Interviews were administered to breast cancer patients admitted to five hospitals in the Baltimore metropolitan area. The study of reserpine use was conducted for a period of approximately one and a half years and information on reserpine use was obtained on 164 breast cancer cases. Each case was matched with a control with respect to age, color, hospital of admission, and admission date. An additional set of controls was drawn from women residing in the same neighborhood as the cases. Neither reserpine, methyldopa, nor thiazides were found to be significantly associated with breast cancer. The exclusion from the analysis of hospital controls with a diagnosis of hypertensive disease and their matched cases did not significantly alter the results. Those cases who used reserpine, used more for longer periods of time than did the controls, however this was judged inconclusive due to a considerable amount of missing data. After comparison of these results with previously reported studies, it did not appear that reserpine was strongly associated with breast cancer. However, because of methodological problems and differences between the studies, a possible small overall relationship could not be definitely excluded.

Methyldopa and propranolol or practolol in moderate hypertension

The effect of a low dose of methyldopa combined with (a) a non-selective and (b) a selective beta-adrenoceptor antagonist was studied in a double-blind crossover trial in 24 carefully selected patients with moderate hypertension (mean initial lying blood pressure 189/117 mm Hg). Each patient received methyldopa 750 mg/day, propranolol 240 mg/day, practolol 600 mg/day, methyldopa 750 mg/day combined with propranolol 240 mg/day, methyldopa 750 mg/day combined with practolol 600 mg/day, and placebo for four weeks each according to a random sequence. After four weeks of therapy the most effective treatment, methyldopa combined with propranolol, reduced lying and standing blood pressures by 36-5/21-4 mm Hg and 44-7/25 mm Hg respectively. Thic combination had similar effects to those of the combination of methyldopa with the cardioselective agent practolol except that it reduced lying diastolic pressure further. The combination was more effective than either treatment alone. No significant differences were found between the effects of propranolol, practolol, or methyldopa at the doses used.