Using a tracer injection technic, modified to provide accurate and repeated determinations of cardiac output in the ambulatory patient, the authors have shown that chronic pentolinium therapy for hypertension lowers blood pressure by reducing cardiac output in the seated position. From these observations and the work of others, they believe that the effect of ganglionic blockade on venoconstrictor tone deserves greater emphasis.D ESPITE the widely accepted use of ganglionic-blocking agents in the treatment of severe hypertension, surprisingly little is known of the mechanism whereby the blood pressure is reduced in the ambulatory patient. In particular, it has not been possible heretofore to make repeated observations of the effect of these agents on the cardiac output in the orthostatic hypertensive patient before and at various time intervals following initiation of treatment. This report deals with certain modifications of the dye injection method for cardiac output, which permits such repeated examinations, and is, to our knowledge, the first study of the effect of chronic pentolinium* treatment on the cardiac output and peripheral resistance in hypertensive patients.
METHODSPatients studied were those with severe essential hypertension (blood pressures of 186-225/117-129). The cardiac output was performed in the seated position. The dye-dilution method of Stewart and Hamiltonl-5 as modified by Pritchard and his group' for the use of iodinated serum albumin (RISA) was the basic principle used in measuring cardiac output, except that arterial samples were collected in tubes rather than passed through the counting device
A gas chromatograph has been used to analyze gases for the measurement of pulmonary diffusing capacity using the breath-holding technique. The gas mixture used for the measurement consisted of carbon monoxide in air with neon as the insoluble inert gas. The calculated DlCO was unaffected when sulphur hexafloride (SF6) or He was substituted for Ne in the mixture, but since CO and Ne could be most simply and rapidly analyzed, this combination was preferred for the gas mixture used to measure DlCO. The mean DlCO for ten normal subjects was 25.8 ± 4.2 ml/min mm Hg. These results were comparable to values reported in the literature when established methods of analysis were used. An excellent correlation was found between calculated DlCO and the clinical condition of patients with impaired pulmonary diffusing capacity. Submitted on February 14, 1962
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