Abstract

Attempts to lower the blood pressure in hypertension are not necessarily harmful, since hypertension can be shown to be the cause of many complications of the disease and its reduction by a number of recently available drugs can be demonstrated to be fraught with few serious consequences except for occasional coronary or cerebral thrombosis or renal failure. Of the recent effective agents, the veratrum alkaloids and hexamethonium are the most potent, but their use is attended by many undesirable side effects closely associated with therapeutic efficacy, whereas hydrazinophthalazine and dihydrogenated ergot alkaloids are less effective, but cause fewer side effects. There is no question that these drugs often have very satisfactory effects when administered in acute hypertensive emergencies. On the other hand, none is able to maintain a persistently normal blood pressure over many months, and all suffer the disadvantage of requiring continuous administration, probably throughout the life of the patient. This represents in itself a very major problem. Until more is known of the varied etiology of hypertension, these therapeutic agents are far from ideal, although they represent a remarkable advance from the therapeutic nihilism present only a few years ago. The reviewers would like to recall that older methods of management by psychotherapy, diet and sympathectomy, while not always effective, are still to be preferred, the first two in the less severe cases, and the last when other methods have proven unsuccessful. The report of Smithwick (257) on the greatly improved survival rates of sympathectomized as compared to medically treated patients, in spite of the fact that the reduction in blood pressure is often not permanent, makes us recall the saying of Hippocrates: "What drugs cannot cure, surgery can." However, we have now reached a stage, with the aid of experimental pharmacology, where we can choose from among several ways to combat hypertensive disease. We may conclude with Professor J. McMichael (163) that, "The desire to find benefit for our patients and enthusiasm for the ‘latest’ must be tempered with critical insight. The present mood, however, is one of quiet optimism."