Guanethidine, a new synthetic hypotensive drug that probably interferes with release of norepinephrine from sympathetic nerve endings and that does not inhibit parasympathetic activity, has proved an effective agent in reducing blood pressure in 25 hypertensive patients studied for periods up to 6 months. Untoward effects have been limited to orthostatic hypotension and mild diarrhea.
The drug apparently lowers blood pressure by reduction in cardiac output rather than by relaxation of the arterioles. Reduction in renal blood flow and glomerular filtration rate accompanied administration of the drug, but in no case did progressive azotemia or oliguria occur.
This agent is an extremely potent hypotensive drug with a remarkably prolonged duration of action and with none of the parasympatholytic side effects produced by ganglionic-blocking agents.
In each of seven patients studied by cardiac catheterization more than 2 weeks after extensive pericardiectomy, performed because of constrictive pericarditis, normal right heart pressure-pulse contours were demonstrated.
The extensiveness of pericardial removal seems the most likely explanation for the normal catheterization findings, which contrast with demonstration by other workers of persistence for periods up to 2 years of the "W"-shaped atrial pressures and high end-diastolic ventricular pressures characteristic of pericardial constriction.
Clinical findings, abnormal right heart pressures, and surgical considerations are presented for a total of 11 patients with constrictive pericarditis who were subjected to pericardiectomy between 1955 and 1960.
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