Lung changes during hexamethonium therapy for hypertension.

During the course of treating 54 severely hypertensive patients with parenteral hexamethonium bromide, wehave observed the development of unexpected pulmonary dyspnea and associated radiographic changes in the lungs in three cases after 7, 9, and 12 months' therapy respectively. Two of these came to autopsy; the third has recovered. The object of this paper is to record the clinical, radiological, and pathological aspects of these pulmonary changes. Complications such as disabling headaches, cardiac enlargement, or renal damage were present in all cases in this series, and in seventeen the disease was in an acute malignant or pre-malignant phase. The dose of hexamethonium required varied from 50 mg. to over 600 mg. three times daily. The blood pressure was controlled at levels 30-90 mm. Hg systolic and 10-40 mm. Hg diastolic below the pre-treatment averages. The three patients here recorded all required large doses of hexamethonium, but others who received as much or more of the drug for periods up to 27 months have shown no lung changes.