Charles Heider

The effect of treatment on the vascular deterioration associated with hypertension, with particular emphasis on renal function☆

Abstract Renal clearance studies were performed in 133 patients with hypertensive vascular disease, 116 of whom were followed for a period of two to five years. In sixty-four of these patients serial renal function studies were performed. Forty-five of the sixty-four were treated and nineteen were untreated. Comparison of treated and untreated patients showed that effective reduction of the blood pressure arrested the renal vascular deterioration associated with hypertension in patients with severe and moderately severe hypertension. Untreated patients with mild and moderately severe hypertension did not show the rapid renal deterioration that occurs in patients with more marked elevation of the blood pressure. The mortality was significantly lower in treated patients than in untreated patients. Renal deterioration was arrested and mortality reduced in patients with malignant hypertension who were treated. Five patients with hypertension due to unilateral renal artery occlusion were studied. Glomerular filtration rate and renal blood flow were reduced significantly in the contralateral kidney as a result of the severe hypertension exhibited by these patients. This vascular deterioration in the unoccluded kidney could be arrested and was partly reversible when the blood pressure was reduced effectively. These results indicate that renal deterioration can be arrested by effective treatment of hypertension and that the lives of hypertensive patients can thus be prolonged. It is recommended therefore that hypertensive vascular disease be treated vigorously and early in the hope of decreasing the morbidity and mortality which too commonly result from this disease.

The vascular status of a heterogeneous group of patients with hypertension, with particular emphasis on renal function

Abstract The renal functional status of 133 patients with hypertension was determined by means of clearance tests. An attempt was made to correlate the renal damage (and other complications of hypertension) with the blood pressure elevation. The results are in general agreement with those obtained by other investigators. There is a definite decrease in glomerular filtration rate and renal blood flow for the group as a whole. As the blood pressure increases there is a progressive decline in renal function and an increased incidence of complications in these patients. Age, sex and race did not appear to influence the disease process in this group of patients. The patients with malignant hypertension tended to have greater renal damage in association with more severe generalized vascular disease.

CHLOROTHIAZIDE POTENTIATION OF GANGLIONIC BLOCKADE IN PATIENTS WITH HYPERTENSION

An earlier study of chlorothiazide in the laboratory revealed it to be an effective nonmercurial diuretic in the laboratory and in man.3 It was found to produce an increase of sodium excretion equivalent to that of parPnterally administered mercurial diuretics. In the course of studying the effect of this compound it was given to a small number of patients with hypertension who were being treated with ganglionic blocking agents. In addition to the diuresis that occurred in these patients it was noticed that some of them had a significant decrease in blood pressure below previously well-controlled and stabilized levels without a change in the dose of the blocking agent. As a result of these observations we decided to study the effect of chlorothiazide on blood pressure in patients under treatment for hypertension. Since chlorothiazide produced no changes in blood pressure in the laboratory animal,2.3 its effect on blood pressure in hypertensive patients under treatment with ganglionic blocking agents was thought to be one of potentiation. This study was performed in order to test this hypothesis.

Renal vascular disease as a cause of hypertension

Abstract Renal arterial occlusive disease is an important and potentially curable cause of diastolic blood pressure elevation. However, renovascular disease with resultant renal functional impairment is commonly the inevitable result of persistent primary diastolic hypertension. In the latter instances, the associated vascular injury may be arrested by appropriate antihypertensive therapy.