The Treatment of Essential Hypertension with Pentolinium Tartrate Combined with Rauwolfia Alkaloids

Bain, C. W. Curtis; Ashton, F.; Jones, B. P.

doi:10.1136/bmj.1.4917.817

Cited by 12 publications

(4 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The daily dose of reserpine administered to these patients was quite small. This is of importance, as the drug is in vogue as a hypotensive agent, being also combined with pentolinium tartrate for the treatment of hypertension (Smirk et al, 1954;Bain et al, 1955;Doyle et al, 1955). Furthermore, Smirk and McQueen (1955) reported that reserpine therapy had to be abandoned in one of their patients on account of fluid retention with recurrence of the manifestations of congestive cardiac failure.…”

Section: Problem Resultsmentioning

confidence: 99%

Cardiac Failure with Reserpine

Marley¹,

Pare²

1956

BMJ

View full text Add to dashboard Cite

Reserpine (" serpasil ") is a colourless crystalline esteralkaloid derived from the roots of Rauwolfia serpentina, and is useful both as a hypotensive agent and as a sedative in psychiatric practice. During the treatment of out-patients attending hospital we were surprised to discover two cases of cardiac failure occurring apparently in association with the administration of this drug. The two relevant case histories are presented. The results of the investigations suggest that reserpine causes a retention of fluid in the body, a factor which may result in heart failure in susceptible subjects. When next seen she was in cardiac failure with cyanosis of the lips and dyspnoea at rest. On examination marked atherosclerosis was found, the blood pressure being 110/75 with a pulse rate of 92 a minute. The apical impulse lay in the fifth left interspace outside the mid-clavicular line and a loud presystolic triple rhythm could be heard over the lower end of the sternum. In addition there were crepitations at both lung bases. The jugular venous pressure was raised 4 cm. above the sterno-clavicular angle, the liver edge being palpable two fingerbreadths below the right intercostal margin. There was no ascites, although pitting oedema of both ankles was present.Reserpine was withheld. She was advised to rest in bed but refused to do this, remaining fullT ambulant. When she returned again four weeks later no evidence of failure remained, and the presystolic triple rhvthm had disappeared. InvestigationData were collected in order to assess the possibility of fluid retention in patients receiving reserpine.' Nine patients suffering from mild psychiatric disorders were given reserpine in increasing doses for three weeks. The drug was then stopped and the investigations were continued for a further three weeks. As the patients were also having weekly injections of acetylcholine, it was necessary, in addition to using the patients as their own controls, to have a control group of patients receiving acetylcholine alone. Six similar patients on weekly injections of acetylcholine were therefore studied concurrently over five weeks. Both groups of patients were selected at random. Dosage varied from patient to patient, depending upon the side-effects of the drug. The mean dailv dosage in the first, second, and third weeks was, 1.6, 2.5, and 3.3 mg.respectively. The maximum individual daily dosage was 9 mg.Blood was withdrawn at the beginning of the investigation and weekly thereafter, estimations being carried out for haemoglobin, plasma portion of the haematocrit, mean corpuscular haemoglobin concentration, and serum sodium. In addition the patient was weighed at each visit.It is readily acknowledged that tfie assessment of these indirect indices for fluid retention provides no accurate picture of alterations in either extracellular or total body fluid, but it is hoped that the presentation of these results will serve as a stimulus for a more elegant survey of the problem.ResultsThe accompanying charts show the changes in weight (...

show abstract

Section: Problem Resultsmentioning

confidence: 99%

Cardiac Failure with Reserpine

Marley¹,

Pare²

1956

BMJ

View full text Add to dashboard Cite

show abstract

“…This dosage is increased until satisfactory control of the blood pressure is achieved; the final dosage may be from 60 mg. to 500 mg. daily. Smirk et al (33) and Bain et al (34) have described this method. The combination with reserpine allows a smaller dosage of pentolinium to be used, and the blood pressure fluctuates less with this than with the ganglion‐blocking agent alone.…”

Section: Methods Of Treatmentmentioning

confidence: 99%

Hypertension

Graham

Maxwell

1956

J American Geriatrics Society

View full text Add to dashboard Cite

The good life expectation of the majority of patients with elevation of the blood pressure tends to obscure the high morbidity and mortality among those who have symptoms and signs referable to their raised arterial tension.The essential mechanical factors in determining the level of the blood pressure are the cardiac output, the volume and viscosity of the blood, and the peripheral resistance. The latter is a function of the calibre of the arterioles, the pressure level being modified by the elastic recoil of the main arteries. Wood (1) has noted that hypertension may be mainly systolic or mainly diastolic, the upper limits of normal being 150/90 mm. of mercury. In view of the different factors involved in systolic and diastolic hypertension, use of the mean arterial blood pressure (M.A.B.P. = (systolic B.P. + diastolic B.P.)/2) is unsatisfactory.Systolic hypertension. The ejection of blood by the left ventricle produces a wave of pressure throughout the arterial system. An increase in the systolic pressure follows exertion, emotional stress, administration of adrenergic drugs, and hyperthyroidism. Loss of elasticity due to arteriosclerosis results in a relatively benign systolic hypertension, although there is an increased strain upon the left ventricle and, in some patients, an insufficiency of peripheral blood flow.Diastolic hypertension. The peripheral resistance to the arterial pressure is determined by the blood flow through the arterioles. Elevation of the diastolic level of the blood pressure follows sympathetic arteriolar constriction. A sustained level of diastolic hypertension is prejudicial to life. It is with this condition of essential hypertension that we have been primarily concerned, since drugs are now available which allow reduction in the levels of the blood pressure to an extent demonstrably greater than that obtainable by general methods of treatment. CLASSIFICATION

show abstract

“…A preference for pentolinium was expressed by two patients (Cases 2 and 5) who have had extensive experience of ganglion-blocking agents. Bain et al (1955) have shown that combination of reserpine with pentolinium enabled reduction in dosage of the latter and thereby a decrease in side-actions. Combined dosage of reserpine and ecolid was used in the maintenance treatment of Cases 7-12, reserpine, 2 mg. by mouth, being ECOLID BRITISH MEDICAL JOURNAL given in the evening.…”

Section: Clinical Investigationmentioning

confidence: 99%