Joseph J. Ursprung

Guanadrel sulfate compared with methyldopa for mild and moderate hypertension.

In a two‐year study of 547 hypertensive patients receiving diuretics, the addition of guanadrel sulfate or methyldopa reduced elevated blood pressure to a similar degree and provided good control in 70% of the patients. Guanadrel‐treated patients experienced less frequent and less severe drowsiness than methyldopa‐treated patients. The frequency of morning orthostatic faintness was low and similar in both treatment groups. Guanadrel produced no tissue toxicity. Guanadrel sulfate, a postganglionic sympathetic inhibitor, is nearly free of central nervous system side effects and is recommended over methyldopa for step 2 therapy when diuretics alone fail to control mild or moderate hypertension.

Chapter 18. Atherosclerosis

Publisher Summary Knowledge in the field of atherosclerosis is expanding at a very rapid rate. Many factors have been implicated in its genesis such as diet, heredity, stress, obesity, hypertension, metabolic disorders such as diabetes and hypothyroidism, climate, and smoking. Probably no single factor alone produces the degenerative changes seen in advanced atherosclerotic disease. There is circumstantial evidence that manipulation of one or several of these basic factors benefits at least some percentage of the population. There also seems to be sound evidence that vigorous dietary measures along with the use of drugs can bring serum lipid levels to a normal value and that these measures may prevent a considerable majority of coronary heart disease and atherosclerosis cases. Atromid S is a powerful medicine against coronary artery disease. A very promising method of treatment is emerging in the use of bile acid sequestering agents. This therapy provides safety along with a method of lowering cholesterol levels that is highly physiologic in nature. Study of the mechanism of thrombosis and its inhibition by drugs affecting platelet aggregation is proceeding at a rapid rate and shows promise for future application. The application of Prostaglandin E 1 , a material occurring naturally in humans, in this area is an intriguing possibility. The study of atherosclerosis and its prevention remains one of the most vigorous and perhaps one of the most important areas in medical research.

Chapter 16. Atherosclerosis

Publisher Summary There is clearly no unified concept of atherogenesis. Knowledge in this field is chaotic and treatment, or prevention, is still a matter of opinion. The preferred method for inhibiting atherogenesis is still the control of the diet. There is evidence that shows that substituting unsaturated for saturated fats in the diet causes a plasma–tissue redistribution, rather than inhibiting the synthesis or increasing excretion rates of cholesterol. Dietary cholesterol seems to play only a minor role, if any, in the development of human atherosclerosis. Drugs that lower serum lipids are still scarce. Efficacy of p-chlorophenoxy isobutyric acid (CPIB) on the long term treatment of the disease remains to be seen. However, cholestyramine, D-T4, estrogens, and nicotinic acid are likely to find special usage for this purpose. Increased activity has focused attention on platelet adhesiveness, although no promising agent has emerged as yet. The fibrinolytic enzymes still are the best agents for fibrinolysis therapy. A start has been made in unraveling psycho–social factors and relating behavior with serum lipid patterns and proneness to coronary heart disease. Although research in atherosclerosis is still in its infancy, with increasing interest by medical scientists and by governmental agencies progress at an accelerated rate is expected.