Untreated and Treated Patients with Hypertension

Observations have been made on renal hemodynamics in patients with hypertension. When the blood pressure was markedly elevated glomerular filtration rate was reduced consistently, indicating renal damage. Effective reduction in blood pressure with anti-hypertensive drugs arrested the vascular deterioration associated with severe hypertension. This occurred in both patients with malignant hypertension and in those with non-malignant hypertension. The drug therapy of hypertension can be divided into (1) the treatment of emergencies associated with severe essential hypertension and (2) the out-patient management of hypertension. As a general rule, reserpine given parenterally is the drug that should be used initially for treating emergency states. When this is not adequate a ganglionic blocking agent or a parenterally administered veratrum preparation should be used. The treatment of ambulatory patients consists of pre-medication with chlorothiazide for depleting the amount of sodium in the body followed by drugs which depress the sympathetic nervous system. Of the sympathetic depressants, we prefer to use rauwolfia initially. When this agent, given in combination with chlorothiazide, is not adequate in any patient with severe and maintained blood pressure elevation, then a ganglionic blocking agent should be added to the regimen. Adequate precautions should be taken to minimize the severity of the side refactions associated with the ganglionic blocking agents.