Results of prolonged treatment with pentolinium tartrate with special reference to the addition of Rauwolfia, hydralazine or both.

A series of 96 patients with severe hypertension has been treated with pentolinium tartrate for an average period of 12 months. Seventeen patients died. Therapy was more effective in arresting changes in the optic fundi and in the heart than in the kidneys. Various combinations of hypo-tensive agents were tested and it was concluded that in general the combination of pentolinium tartrate, Rauwolfia and hydralazine resulted in the greatest reduction of blood pressure with the least degree of side effects due to ganglionic "blockade." S OON after pentolinium tartrate was synthesized by Libman, Pain and Slack,' pharmacologic studies by Wein and Mason2 indicated that it was a potent gangli-onic blocking agent with a prolonged duration of action. Preliminary clinical results were reported by Campbell and Maxwell,3 Smirk4 and from this clinic.5 These reports indicated that pentolinium tartrate was an orally effective, potent, antihypertensive drug that appeared to be useful in the treatment of patients with more severe, fixed types of hypertension. In the present report, the long-term experience with pentolinium tartrate both alone and in combination with certain other hypotensive agents is presented. MATERIALS AND METHODS The treatment group consisted of 96 patients selected because of severe, sustained hypertension (table 1). Their ages ranged from 27 to 65 years, 856 with an average age of 47 years. All except 15 of these patients were hospitalized prior to or during the initiation of treatment with pentolinium. Prior to therapy, 56 per cent exhibited grade III or more changes in the optic fundi and 39 per cent had some degree of nitrogen retention. Electrocardiograms were taken of 83 patients and 66 exhibited the pattern of left ventricular hyper-trophy. Frank congestive heart failure was diagnosed in 13 of the patients, although lesser degrees of cardiac decompensation as manifested by exertional dyspnea were common. Cardiac enlargement was present in 58 of 76 patients who had roentgenograms taken prior to treatment. The method of adjusting dosages of pentolinium tartrate has been described in previous communications .6-8 The duration of treatment ranged from 3 to 27 months, with a mean of 12 months. Seven were treated for 24 months or longer, 44 were treated from 12 to 24 months, 26 from 6 to 12 months, and 18 from 3 to 6 months. In the majority of the cases, various other hypotensive agents were added to pentolinium tartrate for periods of time as are described below.