Prolonged Hypotensive Reaction to Hexamethonium

Abstract

patients in the group who had hypertensive vascular dis¬ ease plus superimposed toxemia, and showed grade 1 hypertensive retinopathy prior to the toxemic episode, showed grade 2 retinopathy six weeks post partum. All the patients with true toxemia showed a generalized retinal sheen, a wet, glistening appearance of the retinas. Though not a specific finding for toxemia, its importance lies in the fact that it is not seen in uncom-plicated hypertensive vascular disease. Examination of the retinas in 25 of the true toxemic group six weeks post partum revealed no abnormality. In 20 patients, however, despite return of the blood pressure to normal and disappearance of edema and albuminuria, examina¬ tion of the retinas revealed definite retinopathy. These retinal changes are attributed to the duration of the toxemia rather than to its severity.Recently hexamethonium compounds have been widely utilized in this country for the therapy of hypertension. Hexamethonium compounds are anticholinergic drugs that block sympathetic and parasympathetic ganglions of the autonomic nervous system. Side-effects from these compounds are a result of parasympatholytic effects resulting in obstipation, ileus, blurred vision, dryness of the mouth, and urinary retention, and sympatholytic effects resulting in severe hypotension with possible exacerbation or precipitation of cerebral, cardiac, or renal damage. The purpose of this report is to present three cases that will emphasize the prolonged hypotensive reaction that may result from the oral administration of hexamethonium compounds. REPORT OF CASESCase 1.\p=m-\A48-year-old Negro woman was first seen at Charity Hospital outpatient department in April, 1952. A few days before, she had been seen in another department, with a chief complaint of weakness, visual blurring of three weeks' duration, and a history of hypertension for six years.