The use of minoxidil in the treatment of severe essential hypertension: a report on 100 patients.

1. One hundred patients with severe essential hypertension have been treated with minoxidil for a mean period of 8-4 months in a study involving eleven European centres. Seventy-two males and twenty-eight females were included in the group; the mean age was 55 years and the initial supine systolic and diastolic pressures averaged 212 (range 150-270) and 125 (range 90-150) mmHg respectively. 2. Reduction of supine diastolic pressure to less than 100 mmHg occurred in 94% of patients within 4 weeks. After the average follow-up period of 8-4 months the mean pressures were 151/91 mmHg. Concomitant therapy with beta-receptor-blocking agents and diuretics resulted in satisfactory control of heart rate and weight gain. 3. Side effects included increased hair growth, nausea, fatigue, rash and darkening of the skin. ECG showed mainly T-wave changes and echocardiographic examination indicated improved ventricular emptying.

Letter: Prostaglandins and induction of labour.

PIP: Professor Brosens and others (April 27, p.808) suggested that the use of prostaglandins (PGs) for induction of labor in pregnancies complicated by hypertensive states might result in a high incidence of fetal distress. Our program of PG clinical investigation has, over the past 3 years, generated case records of 1044 women whose labor was induced with either PGF2alpha or PGE2. Among these records are reports of 283 cases in which the reason for inducing labor was either preeclamptic toxemia or hypertension. The mean Apgar scores at 1 and 5 minutes for the infants in this group were 8.15 and 9.42 respectively. The respective modes were 9 and 10. Of the 4 infants with an Apgar under 5 at 5 minutes, 2 had midcavity forceps deliveries for fetal distress in the 2nd stage. All infants were followed up for at least 1 week after delivery and, at that time, all were normal. It is submitted that these figures do not suggest an abnormal incidence of fetal distress. With regard to the animal studies which Brosens and his colleagues suggested, the article by Clark et al. is of interest. These workers infused PGF2alpha into uterine arteries of pregnant dogs in doses of between 1 and 100 mcg/minute, and were unable to demonstrate any alteration in vascular tone. It should be remembered that the usual recommended infusion rate of PGF2alpha for induction of labor in humans is 5 mcg/minute. This suggests that PGs used at the recommended doses for induction of labor are unlikely to compromise the uteroplacental bloodflow. The predictive value in humans of the animal studies suggested is worth considering since marked species differences are well known in the case of PGs. Of importance, however, must be the substantial body of clinical evidence now available on the safety of PGE2 and PGF2alpha when used for induction of labor in those with and without hypertension. The absence of an antidiuretic effect and the established efficacy of PGs in inducing labor preterm suggest that they may become the treatment of choice in these circumstances.^ieng