Effect of Hexamethonium Bromide in Arterial Hypertension

Werkö, Lars; Wade, Geoff; Frisk, A. Rune; Eliasch, Harald

doi:10.1016/s0140-6736(51)91732-1

Cited by 57 publications

(14 citation statements)

References 12 publications

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“…This pattern is different from that commonly observed in normal animals (20,21), in patients without cardiorespiratory disease (4), and in a variety of cardiorespiratory diseases other than mitral stenosis (1,6,8,22 Only five of our patients were found later to have abnormally high left ventricular diastolic pressures, and these were not those who had the most marked drops of pulmonary "capillary" pressure at catheterization.…”

Section: Discussioncontrasting

confidence: 94%

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Studies of Pulmonary Hypertension. Ix. The Effects of Intravenous Hexamethonium on Pulmonary Circulation in Patients With Mitral Stenosis1

Yu¹,

Nye²,

Lovejoy³

et al. 1958

J. Clin. Invest.

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During the past five years, circulatory effects of intravenous hexamethonium have been studied in normal subjects and in patients with various cardiac diseases (1-10). With adequate doses of the drug a significant reduction of the systemic blood pressure was observed in almost all cases. In many patients, particularly those with pulmonary hypertension, a reduction of the pulmonary artery pressure was also seen. However, the pulmonary "capillary" or pulmonary artery wedge pressures were recorded in only a small number of cases and changes of resistances in the pulmonary circuit were seldom studied.The purposes of this paper are: 1) to report the hemodynamic effects of hexamethonium in a series of patients with mitral stenosis, 2) to discuss the probable mechanism of the changes of the resistances and pressures in the pulmonary circuit of these patients, and 3) to stress the therapeutic benefit of hexamethonium in patients with acute pulmonary edema secondary to mitral stenosis. CLINICAL MATERIAL AND METHODTwenty-seven patients with predominant mitral stenosis were studied. There were 10 males and 17 females. Their ages ranged from 13 to 58 years. None of the patients had a significant degree of mitral insufficiency, a demonstrable lesion of other valves, or systemic hypertension.1This study was supported in part by a grant-in-aid (H 222 C7) from the National Heart Institute of the National Institutes of Health, by a grant from the American Heart Association and New York Heart Assembly, and by the Hochstetter Fund and Ernest L. Woodward Fund.2Present address: Department of Physiology, Dartmouth Medical School, Hanover, N. H.8 Postdoctoral Research Fellow, National Heart Institute, United States Public Health Service (1956)(1957)(1958). 4 Trainee, National Heart Institute, United States Public Health Service (1956Service ( -1957.The patients were studied two to three hours after a light breakfast. In all cases 100 to 200 mg. of methyprylon (Noludar®) 5 was given by mouth as premedication.The methods of determining the cardiac output and recording blood pressures have been described in detail in several previous papers (11)(12)(13)(14). The formulae used to derive the resistances and ventricular work against pressures and mitral valve flow were adopted from the papers by Gorlin' and his co-workers (15, 16). The mean pressures were measured by planimetric integration. Pulmonary "capillary" pressure was substituted for pulmonary venous and left atrial pressures. Pulmonary vascular resistance is the resistance between pulmonary artery and pulmonary vein. Total pulmonary resistance is the resistance between pulmonary artery and a hypothetical sink at atmospheric pressure. The difference between total pulmonary resistance and pulmonary vascular resistance is termed "left heart resistance" instead of "mitral valve resistance" (17, 18). It includes the resistance at the mitral valve as well as the resistance to filling offered by the left ventricle in diastole. In patients with pure mitral stenosis, however, most of the ca...

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Section: Discussioncontrasting

confidence: 94%

“…During the past five years, circulatory effects of intravenous hexamethonium have been studied in normal subjects and in patients with various cardiac diseases (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). With adequate doses of the drug a significant reduction of the systemic blood pressure was observed in almost all cases.…”

mentioning

confidence: 99%

Studies of Pulmonary Hypertension. Ix. The Effects of Intravenous Hexamethonium on Pulmonary Circulation in Patients With Mitral Stenosis1

Yu¹,

Nye²,

Lovejoy³

et al. 1958

J. Clin. Invest.

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“…It was recently demonstrated in anesthetized, openchest dogs that large doses of guanethidine and reserpine are capable of blocking the reflex venoconstriction that occurs during carotid arterial occlusion or central vagal stimulation (6). The possibility has been considered that blockade of reflex venoconstriction may also play a role in the clinical action of these and other antihypertensive drugs (5,(7)(8)(9)(10)(11)(12). Accordingly, this investigation was undertaken to determine the effects of guanethidine, reserpine, and methyldopa, when given to human subjects in the doses commonly employed clinically, on reflex regulation of forearm venous tone.…”

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confidence: 99%

Effects of Guanethidine, Reserpine, and Methyldopa on Reflex Venous and Arterial Constriction in Man*

Mason¹,

Braunwald²

1964

J. Clin. Invest.

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“…An augmentation of central blood volume has been demonstrated when an erect subject assumes the recumbent position (1-3), after the inflation of an antigravity suit (3,4), following immersion of the body in water (4), after the administration of sympathomimetic amines (5)(6)(7), and when large volumes of blood are transfused to subjects under ganglionic blockade (8). A shift of blood out of the thorax occurs when the erect position is assumed (1,2,9), following the application of spinal and general anesthesia (10), positive pressure breathing (7,11), the Flack maneuver (12), venous tourniquets to the extremities (3), and after the administration of ganglionic blocking agents (13,14). Considerable difference of opinion exists, however, regarding the influence of muscular exercise on the central blood volume.…”

mentioning

confidence: 99%