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ARTICLE |

The Role of Postganglionic Sympathetic Blockade in Antihypertensive Therapy FREE

J. Marion Bryant, MD; Lucian Fletcher, Jr., MD; Natalio Schvartz, MD; Harrison Fertig, MD; Richard B. F. Quan, MD
[+] Author Affiliations

Reprint requests to New York University School of Medicine, 550 First Ave, New York 10016 (Dr. Bryant).


From the Department of Medicine, New York University Medical Center, and the New York University Medical Divisions, Bellevue Hospital, New York.


JAMA. 1965;193(12):1021-1026. doi:10.1001/jama.1965.03090120029007
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Currently, neurogenic blockade is used as a supplement to sulfonamide-diuretics (with or without reserpine) when optimal antihypertensive control is not obtained with these drugs alone. Although the use of neurogenic blocking agents preceded that of sulfonamide-diuretics by ten years, the latter have become first in therapeutic choice.

A combination of chlorthalidone and reserpine produced normotension in 58 of 100 ambulatory outpatients with moderate to severe essential hypertension. Twentytwo of 42 subjects with residual hypertension became normotensive when chlorthalidone-reserpine therapy was augmented with a postganglionic sympathetic blocking agent (debrisoquin sulfate).

In the authors' opinion neurogenic blocking agents, or other potent antihypertensive drugs as adjuncts to sulfonamide-diuretics, are indicated in approximately 40% of patients with moderate or severe essential hypertension. Debrisoquin appears to be more practical, as a supplementary antihypertensive drug, than older related blocking agents.

REFERENCES

Lyons, R.H., et al:  The Effects of Blockade of the Autonomic Ganglia in Man With Tetra-Ethylammonium: Preliminary Observations on its Clinical Application , Amer J Med Sci 213:315-323 ( (March) ) 1947;.
Bryant, J.M., et al:  The Antihypertensive Effects of Chlorthalidone: A Comparative Analysis With Benzothiazide Compounds , Circulation 25:522-532 ( (March) ) 1962;.
Brest, A.N., and Moyer, J.H.:  Management of the Ambulatory Patient With Hypertension , Amer J Cardiol 9:874-879 ( (June) ) 1962;.
Kakaviatos, N., and Finnerty, F.A., Jr.:  Comparison of Chlorthalidone, a Long-Acting Antihypertensive and Diuretic, With Chlorothiazide , Amer J Cardiol 10:570-574 ( (Oct) ) 1962;.
Bailey, N.T.J.: Statistical Methods in Biology , New York: John Wiley & Sons, Inc., 1959;.
Moe, R.A., et al:  Cardiovascular Effects of 3,4-Dihydro-2(1H) Isoquinoline Carboxamidine (Declinax) , Curr Ther Res 6:299-318 ( (April) ) 1964;.
Kakaviatos, N., et al:  Value of RO 5-3307 (a New Post-Ganglionic Vasodepressor Agent) and Chlorthalidone in Severe Hypertension , Circulation 28:746 ( (Oct) ) 1963;.
Stenger, E.G., and Wirz, H.:  Pharmacology and Mechanism of Action of Hygroton , Chemotherapia 1:254-263 (No. (4) /5) 1960;.
Bryant, J.M., et al:  Hyperuricemia Induced by the Administration of Chlorthalidone and Other Sulfonamide Diuretics , Amer J Med 33:408-420 ( (Sept) ) 1962;.
Fertig, H., et al:  Clinical Experiences With Guanethidine in Ambulatory Hypertensive Subjects , New Eng J Med 265:268-272 ( (Aug) ) 1961;.
Perry, H.M., and Schroeder, H.A.:  The Effect of Treatment on Mortality Rates in Severe Hypertension , Arch Intern Med 102:418-425 ( (Sept) ) 1958;.
Harrington, M., et al:  Results of Treatment in Malignant Hypertension: A Seven-Year Experience in 94 Cases , Brit Med J 2:969-980 ( (Nov) ) 1959;.
Perera, G.A.:  Antihypertensive Drugs Versus Symptomatic Treatment in Primary Hypertension , JAMA 173:11-13 ( (May 7) ) 1960;.
Perry, H.M., Jr.: " The Effect of Blood Pressure Reduction on Prognosis in Hypertension " in Moyer, J.H. (ed.): First Hahnemann Symposium on Hypertensive Disease , Philadelphia: W. B. Saunders Co., 1959;.
Lee, R.E., et al:  Freedom From Cerebral Vascular Accidents During Drug-Induced Blood Pressure Reduction in "Benign" Hypertensive Disease , Amer J Cardiol 11:738-742 ( (June) ) 1963;.

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Lyons, R.H., et al:  The Effects of Blockade of the Autonomic Ganglia in Man With Tetra-Ethylammonium: Preliminary Observations on its Clinical Application , Amer J Med Sci 213:315-323 ( (March) ) 1947;.
Bryant, J.M., et al:  The Antihypertensive Effects of Chlorthalidone: A Comparative Analysis With Benzothiazide Compounds , Circulation 25:522-532 ( (March) ) 1962;.
Brest, A.N., and Moyer, J.H.:  Management of the Ambulatory Patient With Hypertension , Amer J Cardiol 9:874-879 ( (June) ) 1962;.
Kakaviatos, N., and Finnerty, F.A., Jr.:  Comparison of Chlorthalidone, a Long-Acting Antihypertensive and Diuretic, With Chlorothiazide , Amer J Cardiol 10:570-574 ( (Oct) ) 1962;.
Bailey, N.T.J.: Statistical Methods in Biology , New York: John Wiley & Sons, Inc., 1959;.
Moe, R.A., et al:  Cardiovascular Effects of 3,4-Dihydro-2(1H) Isoquinoline Carboxamidine (Declinax) , Curr Ther Res 6:299-318 ( (April) ) 1964;.
Kakaviatos, N., et al:  Value of RO 5-3307 (a New Post-Ganglionic Vasodepressor Agent) and Chlorthalidone in Severe Hypertension , Circulation 28:746 ( (Oct) ) 1963;.
Stenger, E.G., and Wirz, H.:  Pharmacology and Mechanism of Action of Hygroton , Chemotherapia 1:254-263 (No. (4) /5) 1960;.
Bryant, J.M., et al:  Hyperuricemia Induced by the Administration of Chlorthalidone and Other Sulfonamide Diuretics , Amer J Med 33:408-420 ( (Sept) ) 1962;.
Fertig, H., et al:  Clinical Experiences With Guanethidine in Ambulatory Hypertensive Subjects , New Eng J Med 265:268-272 ( (Aug) ) 1961;.
Perry, H.M., and Schroeder, H.A.:  The Effect of Treatment on Mortality Rates in Severe Hypertension , Arch Intern Med 102:418-425 ( (Sept) ) 1958;.
Harrington, M., et al:  Results of Treatment in Malignant Hypertension: A Seven-Year Experience in 94 Cases , Brit Med J 2:969-980 ( (Nov) ) 1959;.
Perera, G.A.:  Antihypertensive Drugs Versus Symptomatic Treatment in Primary Hypertension , JAMA 173:11-13 ( (May 7) ) 1960;.
Perry, H.M., Jr.: " The Effect of Blood Pressure Reduction on Prognosis in Hypertension " in Moyer, J.H. (ed.): First Hahnemann Symposium on Hypertensive Disease , Philadelphia: W. B. Saunders Co., 1959;.
Lee, R.E., et al:  Freedom From Cerebral Vascular Accidents During Drug-Induced Blood Pressure Reduction in "Benign" Hypertensive Disease , Amer J Cardiol 11:738-742 ( (June) ) 1963;.
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