Observations on angina pectoris during drug treatment of hypertension.

Antihypertensive drug treatment is capable of aggravating angina pectoris in hypertensive patients with coronary artery disease. The complication appears to be due to different hemodynamic mechanisms. Angina pectoris caused by hydralazine may result not only from a reduction in aortic perfusion pressure but also from increases in cardiac output and pulse rate which the drug produces. Coronary insufficiency, after the administration of hexamethonium, is usually associated with severe hypotension and results primarily from a reduction in aortic perfusion pressure. Hexamethonium was not found to prevent the anginal effects of hydralazine. Intravenous hydralazine is a sensitive test for coronary insufficiency but is not without untoward reactions.