Edgar A. Hines

The significance of vascular hyperreaction as measured by the cold-pressor test

Abstract The majority of individuals with essential hypertension and some with usually normal blood pressure manifest unusual lability and marked reactions of blood pressure to various internal and external stimuli. This suggests that the mechanism for regulating blood pressure which is possessed by these individuals is hyperreactive. The cold-pressor test is a satisfactory method of determining the reactivity of the blood pressure. The test consists in measuring the reaction of the blood pressure to a standard cold stimulus. 1 In this paper the expression, person with usually normal blood pressure, will appear frequently. It means a person who does not have persistent hypertension, one whose blood pressure remains within normal limits unless caused to rise by a stimulus. Later in this paper such persons will be divided into the classes called normal hyporeactors and normal hyperreactor.

Livedo reticularis: A peripheral arteriolar disease☆

Abstract We have reported a series of thirteen cases of peripheral vascular disease affecting chiefly the legs and feet which seems to us to be best classified under the term “livedo reticularis,” as described in the literature. The clinical manifestations differ distinctly from those of Raynauds disease, acrocyanosis, and thromboangiitis obliterans. These patients did not have evidence of tuberculosis or syphilis, and the circulatory disturbance developed during adult life. The etiology in our cases is not known. The available data in our cases and others indicate that in livedo reticularis there are usually organic changes in the arterioles of the skin, with chronic vasospasm, which result in regional atony and dilatation of capillaries and slowing of the blood flow. The condition may be complicated by ulceration of the legs and superficial gangrene of the toes. Lumbar sympathetic ganglionectomy resulted in definite improvement in circulation and prevention of further attacks of gangrene in two of our cases and was unsuccessful in one case. It is our opinion that sympathectomy is a justifiable procedure in cases of livedo reticularis in which (1) no definite etiological factor can be found, and (2) superficial gangrene is present.

Blood pressure in the arm and thigh of man

Abstract Blood pressure, pulse pressure, the difference of blood pressure in thigh and arm, and the pulse rate in 112 subjects in the horizontal posture showed great variability from person to person. The tendency of the diastolic blood pressure to increase while the systolic blood pressure remained essentially the same on changing from the horizontal to the standing position is in agreement with the results reported by others. Fifty-nine and five-tenths per cent of all blood pressures fell within 10 per cent, and 86.5 per cent fell within 20 per cent, of the average for the group. These results are almost identical with those of Strang. 16 Differential blood pressures between thigh and arm revealed a wide range of values; the average was 35 mm., systolic, and 27 mm., diastolic, for the horizontal posture. Assumption of the standing posture resulted in a differential pressure of 78 mm., systolic, and 66 mm., diastolic. No apparent correlation was noted between differential pressures and factors such as age, sex, or occupation. No significant differences were found between blood pressures in the left and right thighs of normal subjects. Knowledge of the range of blood pressure in the normal, nonhyperreacting subject, as contrasted to that in the normal, hyperreacting, or hypertensive, hyperreacting subject, is particularly important for those who are trying to evaluate therapeutic attempts to lower or raise the blood pressure.

The circulation in man in certain postures before and after extensive sympathectomy for essential hypertension

Abstract In a previous paper 1 we reported some of the physiologic effects on the circulation of extensive splanchnic sympathectomy and postural change in cases of essential hypertension. The studies to be reported in this paper were made on the same ten patients (Cases 1 to 10). In general, the same air-conditioned room and basic procedure, including the same dates of study, were employed in both instances. This part of the investigation was concerned with modifications of blood pressure and pulse rate by (1) a tight abdominal binder, (2) bilaterally inflated cuffs around the thighs, (3) an abdominal binder plus cuffs around the thighs, (4) exercise of the legs, and (5) the administration of paredrinol sulfate. The blood-pressure-raising effects of some of these agents were compared to similar effects of the cold-pressor test. Controlled observations preceded each of the investigations. Each study was done before and after extensive sympathectomy, and, in most instances, while the patients were in the horizontal and in the 60-degree head-up postures.

Blood pressure in the arm and thigh of man: II. Hydrostatic influences

Abstract Placing a cuff around the thigh and inflating it above the level of systolic blood pressure before subjects assumed the standing posture resulted in a significant, but rather transient, lowering of blood pressure in that thigh when the blood pressure was measured during the period of deflation of the cuff. Possible explanations for this observation are suggested. It appears that most of the increase which occurs in the blood pressure in the thigh when one stands is due to the influence of hydrostatic pressure. There is, however, in a few subjects a homeostatic component in such increases; this is variable, and is distinct from that due to hydrostatic pressure. This homeostatic component may be of considerable magnitude. Elevation of the arm or thigh above the horizontal position resulted in a decrease of blood pressure in the limb; this is apparently also largely related to hydrostatic factors. The posture of a limb in which the blood pressure is measured should be stated, particularly when the limb is not in the horizontal position. For obvious reasons, the horizontal position of the limb is the one in which blood pressure should be measured.

A Comparison of Arm-and-Thigh Blood Pressures in Patients With Abdominal Aortic Aneurysms

systolic pressure of the thigh higher than the systolic pressure of the arm by an average of 38 mm of mercury (range 10 to 88 mm of mercury). In their study of the arm-and-thigh blood pressures of 500 normal men, 18 to 35 years old, Wendkos and Rossman3 used a standard arm blood-pressure cuff (22 inches long with a rubber bag 5H inches wide by 9 inches in length) to minimize variables. Their study thus produced normal values which can be used for comparative purposes by any physician in his office. They found that the faster the pulse, the greater the weight of the patient, and the greater the difference in circumference between the arm and the thigh, the more the blood pressure in the thigh exceeded the blood pressure in the arm. Hamilton and his associates’ confirmed the

ARTERIOSCLEROTIC ANEURYSM OF THE POPLITEAL ARTERY

Arterial aneurysms have been objects of medical curiosity for many centuries (1, 2). Undoubtedly aneurysms of the popliteal artery were among the first to be known to medical science because of their anatomic accessibility and also because, next to the aorta, the popliteal artery is the commonest site of aneurysm. Almost all of the aneurysms of the popliteal artery observed in recent years have been caused by arteriosclerosis. As the number of older persons in our population increases, so will the incidence of arteriosclerotic popliteal aneurysm. This increased incidence, plus the recent advances in anesthesiology and surgery that have made surgical treatment of peripheral aneurysms much less hazardous for patients in the older age groups, has been responsible for the recent revival of interest in this subject. In 1940 Harley (3) reviewed 35 cases of popliteal aneurysm and in 1949 Linton (4) reported 42 cases, in 14 of which he used surgical treatment. The patients having popliteal aneurysm are predominantly men more than 50 years of age. Follow-up data on 69 patients having 100 popliteal aneurysms seen at the Mayo Clinic were reported recently by us ( 5 ) . In our series, 66 of the 69 patients were men and the average age at the time of diagnosis was 63 years. Aneurysms of the popliteal artery are frequently bilateral. This was true in 31 of our 69 patients.

Blood pressure in the arm and thigh of man: III. Effect of venous engorgement

Abstract The production of congestion of an extremity by means of a tight cuff usually results in little change in systolic blood pressure, but, in some cases, it may result in considerable increase in diastolic pressure and a decrease in the intensity of the diastolic auscultatory sounds in that extremity. It is not known why some persons exhibit these tendencies, whereas others do not. Possible mechanisms are discussed. Slow or intermittent deflation of a blood pressure cuff below the level of systolic pressure may tend to increase the value of the diastolic blood pressure in some cases. Suggestions are offered to obviate this tendency.

Blood pressure in the arm and thigh of man: IV. Blood pressure in exercised extremities

Abstract Exercise of the legs resulted in a transient, but considerable, reduction in the diastolic blood pressure in the leg, but little reduction in the systolic blood pressure. The average reduction in the diastolic pressure was 23 millimeters. The systolic blood pressure was reduced, on the average, only 3 millimeters. The prevention of venous return by means of a tight cuff about the thigh while it was being exercised had only a slight effect in preventing the decrease of diastolic pressure in the leg. Other factors besides emptying of the venous reservoirs must be responsible for the decrease of diastolic pressure in the thighs which is noted soon after they are exercised. Certain vascdilator substances produced in the exercised extremity may play a role in such reductions of blood pressure. A soft, continous, blowing murmur, accentuated during passage of the systolic wave along the arteries, was often heard as blood pressure was being measured within the first few seconds after cessation of exercise, or while a cuff which had been kept inflated above the level of systolic blood pressure for a few minutes was being deflated.