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9. Treatment of severe hypertension and hypertensive emergencies with intravenous clonidine hydrochloride.

Author

Niarchos, Andreas P., Baksi, Arun K., Niarchos, A P, and Baksi, A K

Subjects
CLONIDINE, HEART beat, HYPERTENSION, INTRAVENOUS injections, THERAPEUTICS
Abstract

Eleven severely hypertensive patients, median age 54 years, were treated with intravenous (i.v.) clonidine hydrochloride (Catapres). In nine there were life-threatening complications: severe left ventricular failure (LVF), hypertensive encephalopathy, cerebral haemorrhage, dissecting aortic aneurysm, renal failure, and severe epistaxis. In two patients there was pronounced, but uncomplicated, elevation of blood pressure. 0·15 mg or 0·3 mg clonidine was given every 40 min with electrocardiographic (ECG) monitoring. The mean systolic and diastolic blood pressures in the eleven patients were respectively 266 and 165 mmHg before treatment falling to 165 and 109 mmHg after treatment ( < 0·001). The mean decrease in heart rate was 26 beats/min ( < 0·001). Doses of clonidine required for control ranged from 0·15 mg (one ampoule) to 0·9 mg (mean 0·56 mg), although one patient received a total of 0·9 mg without an adequate response. The presenting condition caused the eventual death of two patients. There were no serious side effects, except for one transient episode of sino-atrial heart block. It is concluded that clonidine is effective and safe in the treatment of hypertensive emergencies. [ABSTRACT FROM PUBLISHER]

Published
1973

13. Systemic hypertension associated with coronary artery bypass surgery

Author

Roberts, Arthur J., Niarchos, Andreas P., Subramanian, Valavanur A., Abel, Ronald M., Herman, Steven D., Sealey, Jean E., Case, David B., White, Robert P., Johnson, Garland A., Laragh, John H., Gay, William A., and Okinaka, Arthur J.

Abstract

Systemic hypertension occurs in more than one third of patients having coronary artery bypass graft (CABG) operations. This report describes our studies in 100 consecutive patients undergoing CABG. We found that certain preoperative clinical, angiographic, and biochemical factors predispose to the development of perioperative hypertension. These included a well-documented history of hypertension, an elevated blood pressure the day prior to operation, greater than 50 percent obstruction of the left main coronary artery, and increased levels of dopamine beta hydroxylase (DBH). The hemodynamic pattern of perioperative hypertension was that of an increased systemic vascular resistance which was associated with increased levels of plasma catecholamines and plasma renin activity (PRA). Nitroprusside was shown to be effective in managing CABG hypertension, although other, more specific therapy may be preferable.

Published
1977
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