Systolic time intervals (STI) were recorded serially before and during 1 year of treatment in 367 hypertensive men. The patients were randomly assigned, double-blind, to one of the following regimens: propranolol alone (P), propranolol plus hydrochlorothiazide (P + T), propranolol plus hydralazine (P + H), propranolol plus hydrochlorothiazide plus hydralazine (P + T + H), or reserpine plus hydrochlorothiazide (R + T). Systolic time intervals were calculated by a computer pattern-recognition and measurement program. Diastolic blood pressure and heart rate (HR) decreased with each treatment regimen. The preejection period (PEP) was prolonged following P alone. The left ventricular ejection time (LVET), after correction for HR, was shortened with P + T and R + T and prolonged after P + H. The PEP/LVET was reduced with P + H. The prolongation of PEP during long-term administration of P is comparable with previous studies of its acute effects and suggests a moderate decrease in left ventricular performance. Calculation of STI also appears to be a useful method for showing the effects of adding other antihypertensive agents.

Adolescent↗

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Treatment of hypertension in 1981.

Antihypertensive drugs reduce cardiovascular morbidity and mortality. This was demonstrated by controlled clinical trials. While most complications are dramatically reduced it is not certain whether the incidence of myocardial infarction is decreased by treatment or whether the severity of the infarct is reduced. The prognosis in patients with borderline and mild hypertension varies widely depending on the number of other risk factors present. Patients with mild hypertension and low risk profiles may not obtain enough benefit from treatment to justify the side effects, inconvenience, and expense of such therapy. Such patients should be individually evaluated as to the need and desirability of treatment. Patients who are not treated with drugs should be seen for an annual follow-up to detect progression. Low sodium diets are effective but they are not practical because it is difficult to adhere to the required degree of sodium restriction. Weight-reducing diets also reduce blood pressure but compliance again is difficult, although it is worth advocating for the few patients who will maintain the diet more or less indefinitely. Between 1973 and 1977 in the United States there has been an 8% decline in deaths due to heart disease, a 17% decrease in deaths due to stroke, and an increase in average life expectancy from 71.3 to 72.8 years. Could this be the result of more widespread treatment?

Antihypertensive Agents↗

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The Veterans Administration cooperative study on antihypertensive agents. Implications for stroke prevention.

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Antihypertensive Agents↗

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Adverse effects of diuretics.

Analysis of the available evidence indicates that diuretics do not increase coronary heart disease morbidity and mortality. The multiclinic trials supporting the cardiotoxicity hypothesis are few in number and flawed in design. The majority of the trials, including the well designed trials, indicate no excess of coronary heart disease (CHD) events in diuretic-treated patients compared with those given other drugs or placebo. Recent studies indicate no increase in cardiac arrhythmias after diuretic treatment. Also, although depletion of intracellular potassium and magnesium occurs in patients with congestive heart failure even without diuretics, intracellular concentration of these ions is not significantly reduced by diuretics in patients with uncomplicated hypertension. Modest elevations of serum cholesterol may occur during the first 6 to 12 months of treatment with thiazide diuretics. However, after this time these elevations fall to or below the pretreatment level. The fall may be greater in patients receiving other drugs but the differences are small and their clinical significance is questionable. The incidences of hyperglycaemia and diabetes were only minimally increased in long term clinical trials while the importance of hyperinsulinism and insulin resistance in causing CHD remains unproven in patients. Thiazides remain, therefore, a safe and effective treatment for patients with hypertension.

Diuretics↗

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Excellence in research.

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Research↗