The antihypertensive properties of single doses of furosemide were evaluated in 113 patients. Doses over 120 mg consistently produced a fall in arterial pressure whereas smaller doses did not. Thus 20 of 22 patients (90%) who received more than 120 mg had a 26 + 6% average reduction in mean arterial pressure. The hypotensive action began in 30 to 45 minutes, the nadir of the decrease occurred between 2 and 2X hours, and the hypotension usually lasted 10 to 12 hours. Repeated weekly doses of furosemide over a 2-month period in six patients were not associated with development of drug resistance. The antihypertensive properties of doses of furosemide of more than 120 mg seemed to be of about the same potency as ethacrynic acid. The antihypertensive effect of high doses of furosemide did not seem to be related to the diuretic effect or to the decrease in plasma volume.These studies have demonstrated that doses of furosemide of more than 120 mg consistently decreased arterial pressure. The usefulness of this agent in the long-term management of hypertension remains to be determined.

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Forty-six hypertensive patients have received diazoxide intravenously. Three hundred milligrams (one ampule) administered rapidly undiluted resulted in a 27 per cent average reduction in mean arterial pressure in 1 to 2 minutes. During the next 3 to 5 minutes the arterial pressure increased gradually to a 15 per cent average reduction as compared to the control. The average duration of diazoxide in these patients was 4.7 ± 1.7 hours. No signs of postural hypotension, cerebral ischemia, or collapse were noted. At the peak of hypotensive action there was a 41 per cent average reduction in total peripheral resistance. Repeated doses of diazoxide in both nonpregnant patients with acute hypertension and pregnant patients with toxemia adequately controlled the arterial pressure and were not associatetd with the development of drug resistance. The standard dosage of 300 mg. (one ampule), the immediate onset of action and the moderately long duration of action, the maintenance of cardiac output, the lack of significant side effects, and the fact that it can be administered repeatedly without the development of drug resistance make diazoxide administered intravenously the ideal therapy for acute hypertension.

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The antihypertensive properties of a new imidazoline compound, ST Department of Medicine, Georgetown University School of Medicine, and the Georgetown University Medical Division, District of Columbia General HospitalImidazoline compounds have varying effects on the arterial pressure. Tolazoline (Priscoline) and phentolamine (Regitine) are followed by abrupt falls in arterial pressure, whereas tetrahydrolozine ( Tyzine ) is followed by an immediate rise in arterial pressure, then by a prolonged fall. 7 Although reduction in arterial pressure following these agents is fairly predictable, the short duration of action of tolazoline and phentolamine and the pressor properties of tetrahydrolozine precluded their use in hypertension. A new imidazoline compound which produces a fall in arterial pressure lasting 5 to 6 hours, a decrease in heart rate, and sedation has attracted some attention. 6 , 9, 10, 12 ST 155" (2-[2,6-dichlorpheny lamine] -2-imidazoline hydrochloride) is remarkably similar to tolazoline and

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One hundred nine patients with moderately severe hypertension and 12 patients with severe hypertension received the combination of 50 mg. of chlorthalidone plus 0.25 mg. of reserpine combined in a single tablet (Regroton) administered once daily for an average duration of 2 years. The ease of administration (one tablet daily), the effectiveness (78-per cent good response), the lack of development of drug resistance over a 2-year period, and the small incidence of side effects would seem to make the combination of 50 mg. of chlorthalidone plus 0.25 mg. of reserpine the ideal treatment for most patients with hypertension. If a more rapid reduction in arterial pressure is indicated, as in patients with severe hypertension, or if a satisfactory therapeutic response has not been observed in 3 to 4 months in patients with moderately severe hypertension, suboptimal doses of other antihypertensive agents may be added.

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