trimethaphan-camsylate and Hypertension

Severe hypertension is a common clinical problem in the United States, encountered in various clinical settings. Although various terms have been applied to severe hypertension, such as hypertensive crises, emergencies, or urgencies, they are all characterized by acute elevations in BP that may be associated with end-organ damage (hypertensive crisis). The immediate reduction of BP is only required in patients with acute end-organ damage. Hypertension associated with cerebral infarction or intracerebral hemorrhage only rarely requires treatment. While nitroprusside is commonly used to treat severe hypertension, it is an extremely toxic drug that should only be used in rare circumstances. Furthermore, the short-acting calcium channel blocker nifedipine is associated with significant morbidity and should be avoided. Today, a wide range of pharmacologic alternatives are available to the practitioner to control severe hypertension. This article reviews some of the current concepts and common misconceptions in the management of patients with acutely elevated BP.

Topics: Antihypertensive Agents; Aortic Aneurysm; Aortic Dissection; Clonidine; Diazoxide; Enalaprilat; Female; Fenoldopam; Humans; Hypertension; Labetalol; Nicardipine; Nifedipine; Nitroprusside; Phentolamine; Pre-Eclampsia; Pregnancy; Propanolamines; Trimethaphan

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Calcium Channel Blockers; Clonidine; Diazoxide; Emergencies; Humans; Hydralazine; Hypertension; Hypertension, Malignant; Labetalol; Nitroglycerin; Nitroprusside; Risk; Trimethaphan

Topics: Acute Disease; Aortic Aneurysm; Aortic Dissection; Brain Diseases; Cerebral Hemorrhage; Coronary Disease; Diazoxide; Eclampsia; Female; Humans; Hypertension; Hypertension, Malignant; Monoamine Oxidase; Nitroprusside; Pheochromocytoma; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Pulmonary Edema; Smoking; Substance Withdrawal Syndrome; Syndrome; Trimethaphan; Tyramine

The autonomic nervous system plays a central role in both acute and chronic blood pressure regulation in humans. The activity of the sympathetic branch of the autonomic nervous system is positively associated with peripheral resistance, an important determinant of mean arterial pressure in men. In contrast, there is no association between sympathetic nerve activity and peripheral resistance in women before menopause, yet a positive association after menopause. We hypothesized that autonomic support of blood pressure is higher after menopause in women. We examined the effect of ganglionic blockade on arterial blood pressure and how this relates to baseline muscle sympathetic nerve activity in 12 young (25±1 years) and 12 older postmenopausal (61±2 years) women. The women were studied before and during autonomic blockade using trimethaphan camsylate. At baseline, muscle sympathetic nerve activity burst frequency and burst incidence were higher in the older women (33±3 versus 15±1 bursts/min; 57±5 versus 25±2 bursts/100 heartbeats, respectively; P<0.05). Muscle sympathetic nerve activity bursts were abolished by trimethaphan within minutes. Older women had a greater decrease in mean arterial pressure (-29±2 versus -9±2 mm Hg; P<0.01) and total peripheral resistance (-10±1 versus -5±1 mm Hg/L per minute; P<0.01) during trimethaphan. Baseline muscle sympathetic nerve activity was associated with the decrease in mean arterial pressure during trimethaphan (r=-0.74; P<0.05). In summary, our results suggest that autonomic support of blood pressure is greater in older women compared with young women and that elevated sympathetic nerve activity in older women contributes importantly to the increased incidence of hypertension after menopause.

Topics: Adult; Aging; Blood Pressure; Brachial Artery; Female; Ganglionic Blockers; Humans; Hypertension; Menopause; Middle Aged; Muscle, Skeletal; Peroneal Nerve; Sympathetic Nervous System; Trimethaphan; Vascular Resistance; Vasodilator Agents; Young Adult

Blood pressure usually is reduced in patients with hypertensive intracerebral hemorrhage for the prevention of the expansion of the hematoma and recurrent hemorrhage in acute stage. However, disturbed autoregulation of cerebral circulation is expected, and decreased cerebral blood flow (CBF) caused by excessive hypotension has been pointed out. There are different mechanisms of action in hypotensives, thereby the influence of hypotension on CBF in patients with the thalamic hemorrhage was investigated using nitroglycerin (TNG), diltiazem hydrochloride (DH) and trimethaphan camsilate (TC). Average CBF in a hemisphere on the hematoma side, the hemisphere without hematoma, and around the hematoma showed a slight decline after administration of TNG or DH. However, CBF declined more, after TC than DH. DH and TNG are preferable in descending order to control blood pressure of patients with intracerebral hemorrhage in the acute stages in view of a smaller decline in CBF.

Topics: Adult; Aged; Antihypertensive Agents; Blood Pressure; Cerebral Hemorrhage; Cerebrovascular Circulation; Diltiazem; Hematoma; Humans; Hypertension; Middle Aged; Nitroglycerin; Thalamic Diseases; Trimethaphan

Topics: Acute Disease; Adolescent; Adult; Aged; Antihypertensive Agents; Clinical Trials as Topic; Double-Blind Method; Humans; Hypertension; Intraoperative Complications; Middle Aged; Neuroleptanalgesia; Nicardipine; Nifedipine; Trimethaphan

Topics: Aged; Antihypertensive Agents; Clinical Trials as Topic; Female; Humans; Hypertension; Intraoperative Complications; Male; Middle Aged; Neuroleptanalgesia; Nicardipine; Nifedipine; Random Allocation; Trimethaphan

During clinical testing of the administration of ganglion-blocking agents by inhalation (175 persons) it was established that drug aerosols of arfonad and hygronium possess high effectiveness, act rapidly, and are relatively safe. The inhalation method of the management of hypertensive crises may find wide use in out-patient practice, under conditions of the admission room, cardiological and resuscitation departments, as well as in obstetrics when controlled hypotension is necessary.

Topics: Adult; Aerosols; Bis-Trimethylammonium Compounds; Clinical Trials as Topic; Drug Evaluation; Emergencies; Ganglionic Blockers; Hemodynamics; Humans; Hypertension; Proline; Respiratory Therapy; Skin Temperature; Trimethaphan

Infrarenal aortic cross-clamping performed during vascular reconstructive procedures is often accompanied by systemic supraclamp hypertension. Much of the disease and death that attend aortic cross-clamping centers around hypertension. Many different strategies have been developed to attenuate intraoperative hypertension, and a host of pharmacologic agents are regularly used to lessen the heart-related, cerebral, and systemic effects of clamp-induced hypertension. This study was performed to evaluate two such strategies; the intravenous administration of either trimethaphan camsylate or nitroprusside.. We used a highly controllable and reproducible model of aortic cross-clamping in which we have previously shown the hypertension associated with clamping to be an active process mediated by means of a reflex arc. Ten dogs, five treated with nitroprusside (NP group) and five treated with trimethaphan camsylate (TC group), underwent 90 minutes of aortic cross-clamping. During this 90-minute period each group received 30 minutes of antihypertensive therapy.. Control mean arterial pressure +/- SEM was 80 +/- 5 mm Hg for both groups and increased to 140 +/- 5 mm Hg with clamp application. With antihypertensive treatment the elevation in mean arterial pressure produced by cross-clamping was reduced to preclamp levels in the TC group and only partially (52%) in the NP group, despite very high doses of nitroprusside. Cardiac output (CO) increased in the NP group by 115% and decreased by 36% in the TC group. This increase in CO translates into a large (101%) increase in cardiac minute work for the NP group.. The attenuation of clamp-induced hypertension by nitroprusside is associated with a dramatic increase in CO and cardiac work whereas the use of trimethaphan camsylate is not. The use of this ganglionic blocker may be more appropriate in this setting.

Topics: Animals; Aorta, Abdominal; Cardiac Output; Constriction; Dogs; Ganglionic Blockers; Hemodynamics; Hypertension; Intraoperative Complications; Male; Nitroprusside; Time Factors; Trimethaphan; Vasodilator Agents

Six patients with massive hypertensive intracerebral hemorrhage and showing progression of consciousness-disturbance were treated by CT-guided stereotactic surgery. Serious complications or the age of these patients prevented evacuation of the hematomas by craniotomy under general anesthesia. The increase in the size of the intracerebral hematoma suggested by the progression of the consciousness-disturbance on admission was stopped by controlling the blood pressure. Stereotactic evacuation of the hematoma was performed using Komai's CT stereotactic apparatus 1-4 days after the onset. On the CT slice showing the maximum size of the hematoma, two target points showing each center or two circles which cover the greater part of the hematoma were determined, and then two drainage tubes were inserted into the two target points of the hematoma through two burr holes, and the hematoma was aspirated with a syringe. Postoperatively, every 12 hours, a solution of 60,000IU urokinase in 100 ml saline was irrigated into the hematoma cavity with aspiration of the hematoma, and finally 10 ml urokinase solution was left in the hematoma cavity. By 2-4 repetitions of this procedure, 83-91% of the estimated hematoma volume was evacuated using urokinase (120,000-240,000IU) for 1-2 days. Therefore, all of the cases showed improvement in the consciousness level without rebleeding or progression of serious complications. For large hypertensive intracerebral hematomas in aged patients or patients with serious complications, this stereotactic surgery can be carried out safely and rapidly through two drainage tubes using urokinase after 24 hours from the onset.

Topics: Aged; Cerebral Hemorrhage; Drainage; Female; Humans; Hypertension; Male; Middle Aged; Stereotaxic Techniques; Tomography, X-Ray Computed; Trimethaphan; Urokinase-Type Plasminogen Activator

Topics: Humans; Hypertension; Pulmonary Edema; Trimethaphan; Vasodilator Agents

Topics: Administration, Oral; Captopril; Clonidine; Diazoxide; Emergencies; Humans; Hydralazine; Hypertension; Infusions, Parenteral; Labetalol; Nifedipine; Nitroprusside; Trimethaphan

Topics: Extraction, Obstetrical; Female; Ganglionic Blockers; Humans; Hypertension; Hypotension, Controlled; Obstetric Labor Complications; Pre-Eclampsia; Pregnancy; Trimethaphan

Topics: Autonomic Agents; Emergencies; Hypertension; Trimethaphan

Topics: Autonomic Agents; Blood Vessels; Humans; Hypertension; Trimethaphan; Vascular Resistance

Topics: Anesthesia; Humans; Hypertension; Sympatholytics; Trimethaphan

Topics: Blood Pressure; Electrolytes; Humans; Hypertension; Kidney; Sympatholytics; Trimethaphan; Urine; Water

Topics: Female; Hemodynamics; Hypertension; Pregnancy; Pregnancy Complications; Sympatholytics; Trimethaphan

Topics: Anesthesia, Spinal; Essential Hypertension; Female; Hemodynamics; Hydralazine; Hypertension; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Sympatholytics; Toxemia; Trimethaphan; Veratrum Alkaloids