The treatment of hypertension

Abstract

1. The relationship between cardiovascular disease and hypertension is discussed. The false identification of the two conditions is emphasized, and the benign nature of much of hypertension is stressed. 2. The indications for treatment aimed at reducing arterial pressure are the gravity of the prognosis and, less commonly, the severity of the symptoms. Of the former, malignant hypertension is the most important: evidence of cardiac failure is an indication when hypertension is the main aetiological factor. The height of the blood pressure is not a reliable guide. 3. In attempting the relief of symptoms, care must be taken lest the symptoms induced by treatment exceed those relieved. 4. Age is no contra-indication but senility is. 5. Cerebral and coronary thromboses are contraindications to treatment. There is a place for pressure reduction by medical treatment in some cases of subarachnoid haemorrhage. 6. Renal hypertension is improved by medical treatment in many cases. 7. The various methods available for reducing arterial pressure are discussed. A plea is made for less sedation and for less restriction of activity in mildly hypertensive subjects. 8. The limitations and unpredictable results of sympathectomy are discussed. 9. The most effective weapons at present available are hexamethonium and related compounds. For general use pentapyrrolidinium bitartrate (' Ansolysen') in a retard solution is probably the most reliable agent. The methods of administration are described, together with side effects to be expected. No limit to the duration of treatment can be foreseen in most patients.