Treatment of hypertension with reserpine, with reserpine in combination with pentapyrrolidinium, and with reserpine in combination with Veratrum alkaloids.

The treatment of hypertension with reserpine is described. When used alone it produced adequate falls of blood pressure in ten out of forty patients. The combination of reserpine with veratrum did not increase the hypotensive effects of reserpine alone. The combination of reserpine with pentapyrrolidinium increases the effectiveness of the pentapyrrolidinium and lessens its para-sympathetic side effects. The combination of reserpine and pentapyrrolidinium is regarded as the best therapeutic regime for severe hypertension. Some mild cases of hypertension may be managed with reserpine alone. E XTRACTS of Rauwolifa serpentina have been extensively used in India for several decades in the treatment of a variety of conditions including hypertension.' Their value in treatment of the latter condition has recently attracted worldwide interest. The particular activity as a hypo-tensive agent of reserpine, an alkaloid of Rauwolfia isolated by Swiss workers2 has been investigated in animals by Bein and associates ,3' 4 Trapold and co-workers,5 Plummer and colleagues,6 and McQueen and associates.7 These studies have indicated that in part at least, the hypotensive action of reserpine is mediated through the sympathetic nervous system. Our own studies7 have also shown that in rabbits reserpine has a direct vasodilating action on the blood vessels and suggest that there may be some direct effect in man. In a previous report from this department8 the effects of large doses of reserpine in man were described, and further clinical studies have been published by Loffler and co-workers9, The use of Rauwolfia alkaloids in combination with other hypotensive agents has been reported on by Wilkins'0 (Serpina and Apreso-line), Wilkins and Judson'6 (Serpina and veratrum alkaloids) and Ford and Moyer'7 (Rauwiloid and hexamethonium). A preliminary account'8 has outlined in general terms our own experiences with a combination of reserpine and pentapyrrolidinium. At that time it could be stated that of 40 cases, distinctive benefits had resulted from the use of the combination in 27 (8 classified as very good and 19 as good). Benefit was apparent either in an important decrease of side effects or in improvement in the degree of blood pressure control without increase of side effects, or in a combination of these. Eight were classed as fair, meaning that some specific advantage had been obtained by the combination although this might be of slight degree. In only 5 out of 40 were the results considered poor. It was pointed out that an important advantage of the combination …