Editor's Mail.

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Drugs for hypertension. Seven classes to choose from.

A wide variety of drugs are available for treatment of hypertension. Diuretics, long the sole therapy, can control blood pressure in more than 40% of patients. If a diuretic alone proves inadequate, a beta-adrenergic blocking agent, vasodilator, and central-acting sympathetic inhibitor may be added, as needed, in the familiar four-step program. A calcium channel blocker, with its vasodilating effects, or an angiotensin-converting enzyme inhibitor may be considered in appropriate situations. Selection among these agents should be based on knowledge of their pharmacologic action, duration of action, and side effects. With careful selection, blood pressure can be better controlled, side effects minimized, and patient compliance improved.

Economics of antihypertensive therapy.

Antihypertensive therapy has come a long way in the past 40 years. With the wide range of drugs now available, cost has become an additional consideration in selection of therapy. However, precise figures for comparison of drugs within and between classes can be difficult and time-consuming to gather. The unit-cost tables in this article are presented with the hope that they will simplify the selection process. Of course, unit cost is not the sole criterion to be considered; potency and frequency of administration also influence the overall cost of therapy.

Small center kidney transplantation.

We herein present the results of our first 100 kidney transplants. The 1-year patient and graft survivals were 94 and 74 per cent, respectively, for living related grafts, and 85 and 57 per cent, respectively, for cadaver grafts. These results compare favorably to the recent standards set by the American Society of Transplant Surgeons Standards Committee (95.1, 78.6, 88.6 and 55 per cent). Initial hospitalization averaged 21 plus or minus 7 days, while hospitalization during the first year after transplantation averaged 35 plus or minus 21 days. Average expenses (Medicare reimbursed) during the first 12 months after kidney placement were $29,572 plus or minus $6,468 for 15 successive patients. A total of 22 complications occurred within 1 year of transplantation and 11 required surgical management. Of 24 patients who survived 1 year with loss of graft function 15 (62 per cent) required transplant nephrectomy. Causes of death and types of complications are presented. Our results suggest that high quality kidney transplantation may be available to patients in small transplant centers.

Angiomyolipoma: characteristic images by ultrasound and computed tomography.

The ultrasonographic and computed tomographic images of renal angiomyolipoma are sufficiently characteristic to permit accurate radiologic diagnosis. If low-density, fat-containing areas are demonstrated, a confident diagnosis of renal angiomyolipoma may be made and appropriate management planned.