Why the study?
Does a stepwise pharmacological approach using reserpine, hydrochlorothiazide, and hydralazine improve blood pressure control in patients with hypertension ≥170/100 mm Hg?
Does a stepwise pharmacological approach using reserpine, hydrochlorothiazide, and hydralazine improve blood pressure control in patients with hypertension ≥170/100 mm Hg?
A stepwise approach using reserpine, hydrochlorothiazide, and hydralazine can effectively manage severe hypertension, though specific adverse effects must be monitored.
May support hydralazine addition in refractory hypertension; case-report data leave efficacy and safety open to randomized confirmation.
Most hypertension can be controlled if treatment is begun early and continued on a long-term basis. Forty-nine patients with blood pressures of 170/100 mm. Hg or greater were studied. All received reserpine; 39 who failed to exhibit an adequate response had hydrochlorothiazide added. Ten patients who did not respond to this combination were given hydralazine in addition; three had an excellent response, five good, one fair, and one none. No significant side-effects were caused by reserpine. Reactions to hydrochlorothiazide included nausea, lightheadedness, and mild skin rash. One patient had skin rash, joint pain, and an elevated blood urea nitrogen level due to hydralazine, which had to be discontinued. Patients who do not respond to this combination of drugs may improve with the use of ganglionic blocking agents or guanidine sulfate. Experience with the latter is too small to warrant evaluation.
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Donald A. Dupler (1960) studied this question.
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