Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations.

A double-blind crossover comparison was made in 18 nonedematous hypertensive subjects with glomerular filtration rates exceeding 70 ml/min/1.73 m2 of the effects of 5 mg metolazone and 5 mg bendroflumethiazide on blood pressure and metabolic parameters. After a 4-wk run-in placebo period, patients received either metolazone or bendroflumethiazide for 6 wk in a crossover fashion with an intervening washout period of 4 wk. Metolazone induced a more sustained and greater blood pressure response than bendroflumethiazide. Changes in plasma potassium, urate, bicarbonate, renin, and angiotensin II occurred during treatment with both metolazone and bendroflumethiazide; the only significant difference, however, was in changes in plasma bicarbonate. Total body potassium (TBK), measured by whole-body monitor, did not fall outside the normal range with either metolazone or bendroflumethiazide, although metolazone induced a greater reduction in TBK (6.2 gm, 5.5% of TBK) than bendroflumethiazide (1.2 gm, 1.1% of TBK, p < 0.05). Our results suggest that metolazone is a more effective antihypertensive and induces similar but greater metabolic changes than bendroflumethiazide. The results of our comparison suggest that although changes in plasma potassium and TBK are minor, they are greater with metolazone, and potassium supplements may not be necessary in nonedematous hypertensive patients with normal renal function.

Malignant fibrous histiocytoma with diffuse spinal nerve involvement.

Two cases of malignant fibrous histiocytoma in which paraplegia was a major feature are presented. The histological features of the tumours are discussed with particular emphasis on the neural involvement. A brief review of the literature on the subject is included.

Panhypogammaglobulinaemia caused by gold therapy.

Gold compounds have been successfully used for over 50 years in the treatment of rheumatoid arthritis, but their mechanism of action is unknown. The main disadvantage is the frequent occurrence of side effects which often necessitate discontinuation of therapy. Recently, there have been reports of reduction in immunoglobulin levels in patients on gold treatment; we report a further case of hypoglobulinaemia associated with gold therapy and recommend that immunoglobulins be monitored prior to and during treatment.

The management of hypertension--a survey of opinions among general practitioners.

In order to clarify current opinion on aspects of the management of hypertension, a postal questionnaire was sent to all 420 general practitioners in the Lothian Health Board Area. Three hundred and nine doctors (74 per cent) replied.A high proportion were willing to undertake the investigation and follow-up of most hypertensive patients in general practice but there were conflicting opinions on the use of Phase 4 and Phase 5 in the measurement of blood pressure, the number and type of investigations which were appropriate, the level of diastolic blood pressure at which treatment should begin, and the level to which the diastolic blood pressure should be reduced with treatment.

The management of hypertension--a study of records in general practice.

We investigated the management of a group of 322 hypertensive patients by 71 general practitioners in the Lothian Health Board Area by a survey of the general practitioners' records. Eighty-five per cent of patients were diagnosed by the general practitioner and 57 per cent were cared for entirely by him. Two thirds of the patients were women. Hospital referral was more common in men and in patients with high initial blood pressures. One third of patients had only one blood pressure recorded before treatment. The result of treatment as measured by the latest diastolic blood pressure was similar for patients treated by the general practitioner and those referred to hospital, being 100 mm Hg or less in 77 per cent of patients.

Management of hypertension--a study of hospital outpatient practice.

In this third report on the management of hypertension by general practitioners and hospital physicians we review hospital outpatient practice in a representative sample of 90 new patients and 436 returning patients attending the clinics of three Edinburgh hospitals. Seventyeight per cent of the new patients were seen by a consultant or senior registrar. An unacceptable number of deficiencies was found in clinical assessment and these are discussed. Consultants are shown to be more conservative than junior hospital doctors in their treatment of hypertension.