Skip to main content

Treatment Of isolated Diastolic Hypertension



isolated-diastolic-hypertension-treatmentDiastolic blood pressure is the lowest blood pressure between the two heartbeats. Normal blood pressure of a healthy adult is 120/80 mm of Hg. 120 is systolic blood pressure while 80 is the diastolic blood pressure. Increase in diastolic blood pressure above the normal ranges is called diastolic hypertension.

We are here to discuss 

PHYSIOLOGIC PRINCIPLES UNDERLYING THE TREATMENT OF HIGH
DIASTOLIC HYPERTENSION BY THIOCYANATES
AND SYMPATHECTOMY


The effects of sympathectomy and thiocyanate treatment on the diastolic blood pressure and the adrenal gland were studied by  LOYAL DAVIS, (M.D)., JOSEPH TARKINGTON, (M.D)., AND ROBERT K. ANDERSON, (M.D)

Only the summary and important points of their study are stated here;
Before reading this you must have sufficient knowledge about the different functions and layers of Adrenal gland.

Important points are;
  • Patient response well to Sympathectomy followed by treatment with thiocyanate than treatment with a single agent alone.
other points include;

1. There is a depletion of lipid granules in the three layers of the adrenal cortex of the experimental renal hypertensive dog which has received thiocyanates. This depletion is most marked in the zona glomerulosa. Zona glomerulosa is responsible for the secretion of mineralocorticoids especially Aldosterone. which control blood volume and blood pressure. High aldosterone level means high blood pressure and vice versa. Hence thiocyanate decreases the production of aldosterone by the adrenal cortex and tends to decrease the blood pressure.

2. Withdrawal of the thiocyanates is followed by the reappearance of these sudanophilic fatty granules in the adrenal cortex and return of the blood pressure to the original high level.

3. These changes in the distribution of the lipid granules are similar to those which occur in the adrenal cortex of patients with essential hypertension who have received thiocyanates.

4. The depletion of the lipid granules in dogs with experimental renal hypertension

is more marked after bilateral thoracolumbar sympathectomy. Thoracolumbar sympathectomy is done. sympathectomy decreases the secretion of epinephrine and norepinephrine from the adrenal medulla. low levels of epinephrine will result in low levels of ACTH. which in turn decreases the adrenal cortical secretions. which is responsible for hypotensive effects following adrenal medulla denervation. 

5. It is noticed experimentally that Partial occlusion of the portal vein permanently reduces the systemic blood pressure of dogs with experimental renal hypertension and produces a depletion of the lipid substances in the fasciculata and reticularis layers of the adrenal cortex, with a relative depletion in the zona glomerulosa. fasciculata layer secretes glucocorticoids mainly cortisol and zona reticularis secretes androgens. but partial occlusion of portal vein will result in chronic liver damage which in turn result in a reduction of hypertensinogen production by the liver.

6. If thiocyanate is given intravenously to a dog. it will result in an immediate decrease in blood pressure followed by a rapid rise in blood pressure to a higher value which afterwards slowly return to original hypertensive value. Removal of the adrenal glands is followed by the disappearance of the pressor response which immediately follows the primary depressor effect produced by the injection of thiocyanate in an acute experimental animal.

7. These observations point out that the thiocyanates and sympathectomy affect principally the glomerulosa layer of the adrenal cortex. Cytochemical studies of the lipid granules point to this layer as the important source of the 17-ketosteroids.
They also indicate that the depressor effect of a chronic, mild, insufficiency of the liver produced by partial occlhsion of the portal vein is accompanied by a depletion

pattern of the lipid granules in the adrenal cortex different from that produced by the thiocyanates.


BIBLIOGRAPHY
Davis, Loyal, and M. H. Barker. The Surgical
Problem of Hypertension. Ann. Surg., 107:
899, 1938.
2 Davis, Loyal, and M. H. Barker: Clinical and Experimental Experiences in the Surgical Treatment of Hypertension. Ann. Surg., 110: 1016,
1939.
3 Davis, Loyal, Howard A. Lindberg and N. V.
Treger: The Results of a Special Coordinated
Plan of Medical and Surgical Treatment of
Essential Hypertension. Ann. Surg., 128:
770, 1948.
4 Davis, Loyal, Carlos A. Tanturi and Joseph A.
Tarkington: The Combination of Sympathectomy and Thiocyanates in the Treatment of
Experimental and Essential or High Diastolic,
Hypertension. Ann. Surg., 132: 394, 1950.
5 Davis, Loyal, and Carlos A. Tanturi: The Liver
as a Factor in Experimental Renal Hypertension.

Comments

Popular posts from this blog

Human Parasites, Types of Parasites, and Classification

Parasite: A parasite is a living organism which gets nutrition and protection from another organism where it lives. Parasites enter into the human body through mouth, skin and genitalia. In this article, we will generally discuss the types and classification of parasites. It is important from an academic point of view. Those parasites are harmful, which derives their nutrition and other benefits from the host and host get nothing in return but suffers from some injury. Types of Parasites Ecto-parasite: An ectoparasite lives outside on the surface of the body of the host. Endo-parasite: An endo-parasite lives inside the body of the host, it lives in the blood, tissues, body cavities, digestive tract or other organs. Temporary parasite: A temporary parasite visits its host for a short period of time. Permanent parasite: Permanent parasite lives its whole life in the host. Facultative parasite: A facultative parasite can live both independently and dependently. It lives in the

How to taper off, wean off beta blocker, atenolol, Propranolol, Metoprolol

Beta blockers include, atenolol (Tenormin), propranolol (Inderal ) and metoprolol (Lopressor) and are used to treat high blood pressure, certain cardiac problems, migraine and few other conditions. People usually take atenolol, propranolol or metoprolol for many years as a treatment of high blood pressure or after having an episode of heart attack . Sometimes, it becomes necessary to withdraw these beta blockers due to their potential side effects that trouble the patients or sometimes doctor wants to change the drug and shift the patient to some other anti-hypertensive medicine. No matter whatever the cause is, whenever, a patient who has been using a beta blocker for a long period of time, and he needs to be stopped from further usage of that beta blocker, must not stop taking it. One should taper off the dose of a beta blocker. Now a question arises how to wean off or taper off a beta blocker? The method of tapering off beta blocker varies from individual to individual. Allow you