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Five-year follow-up of minoxidil-treated refractory hypertensive patients
ABSTRACTS:
HIGH
BLOOD
PRESSURE
115
CONTROL
A-165 COMMUNITY INVOLVEMENT IN HYPERTENSION SCREENING AND EDUCATION Health Early Assessment Roseville Task Force, Sue E. Miller, Roseville Community Hospital, Roseville, California; Paul J. Dugan. A group of community leaders instituted a hypertension screening and The goal education project aimed at city residents age 5 and over. of the project was to detect hypertensives and, using multiple resources, to increase the community's awareness of the dangers of high blood pressure. We set three major areas of emphasis: a mass screening, carried out over three consecutive weekends; a full-day seminar with nationally recognized experts in hypertension speaking to health professionals and a junior high school curriculum unit and interested lay persons; on cardiac risk factors, which included teaching students and faculty to take blood pressures. For the mass screening program, we recruited and oriented volunteers, and, where necessary, trained them in taking blood pressures. Committees developed protocols for screening and assembled educational materials. We devised a follow-up mechanism, and identified physicians willing to take referrals from the screening program. The project screened 5191 persons, 24.3% of the eligible population. Of these, 27% had elevated readings. In the schools 850 students were taught to take blood pressures. As a result of the massive publicity, several local organizations and industries are instituting ongoing blood pressure programs. A-166 FIVE-YEAR PATIENTS
FOLLOW-UP OF MINOXIDIL-TREATED
REFRACTORY HYPERTENSIVE
Helen C. Mitchell, The University of Texas Southwestern School, Dallas, Texas; William A. Pettinger
Medical
This study involved twenty-nine severely hypertensive patients who, according to 1972 criteria, were candidates for nephrectomy to prevent strokes, heart attacks, and aortic rupture. These twenty-nine patients were treated with minoxidil/propranolol and diuretic agents for 6-60 months. Good blood pressure control (diastolic < 100 mmHg) was achieved in twenty-one of the twenty-nine patients using up to 40 mg/day of minoxidil. Abnence of tolerance was demonstrated. Good control was achieved in three of the other eight patients by adding phenoxybenzamine, in one with clonidine, and in another by increasing minoxidil dosage to 60 mg/day. In the seventeen currently (4/77) active patients, cardiothoracic ratios increased in nine and decreased in eight. LVH by EKG increased in one, decreased in five, and was unchanged in eleven. Renal failure did not progress in twelve of the seventeen active patients. However, five of the twenty-nine developed renal failure, two from non-compliance, one from glomerulonephritis, and the other two from arteriolar nephrosclerosis. One patient with poor blood pressure control died from a massive cerebral hemorrhage. Another patient had temporary hemiparesis during good blood pressure control. Thus, in the remainder of this particularly high risk group, strokes, myocardial infarction, and rupture of aneurisms were effectively prevented.
HIGH
BLOOD
PRESSURE
115
CONTROL
A-165 COMMUNITY INVOLVEMENT IN HYPERTENSION SCREENING AND EDUCATION Health Early Assessment Roseville Task Force, Sue E. Miller, Roseville Community Hospital, Roseville, California; Paul J. Dugan. A group of community leaders instituted a hypertension screening and The goal education project aimed at city residents age 5 and over. of the project was to detect hypertensives and, using multiple resources, to increase the community's awareness of the dangers of high blood pressure. We set three major areas of emphasis: a mass screening, carried out over three consecutive weekends; a full-day seminar with nationally recognized experts in hypertension speaking to health professionals and a junior high school curriculum unit and interested lay persons; on cardiac risk factors, which included teaching students and faculty to take blood pressures. For the mass screening program, we recruited and oriented volunteers, and, where necessary, trained them in taking blood pressures. Committees developed protocols for screening and assembled educational materials. We devised a follow-up mechanism, and identified physicians willing to take referrals from the screening program. The project screened 5191 persons, 24.3% of the eligible population. Of these, 27% had elevated readings. In the schools 850 students were taught to take blood pressures. As a result of the massive publicity, several local organizations and industries are instituting ongoing blood pressure programs. A-166 FIVE-YEAR PATIENTS
FOLLOW-UP OF MINOXIDIL-TREATED
REFRACTORY HYPERTENSIVE
Helen C. Mitchell, The University of Texas Southwestern School, Dallas, Texas; William A. Pettinger
Medical
This study involved twenty-nine severely hypertensive patients who, according to 1972 criteria, were candidates for nephrectomy to prevent strokes, heart attacks, and aortic rupture. These twenty-nine patients were treated with minoxidil/propranolol and diuretic agents for 6-60 months. Good blood pressure control (diastolic < 100 mmHg) was achieved in twenty-one of the twenty-nine patients using up to 40 mg/day of minoxidil. Abnence of tolerance was demonstrated. Good control was achieved in three of the other eight patients by adding phenoxybenzamine, in one with clonidine, and in another by increasing minoxidil dosage to 60 mg/day. In the seventeen currently (4/77) active patients, cardiothoracic ratios increased in nine and decreased in eight. LVH by EKG increased in one, decreased in five, and was unchanged in eleven. Renal failure did not progress in twelve of the seventeen active patients. However, five of the twenty-nine developed renal failure, two from non-compliance, one from glomerulonephritis, and the other two from arteriolar nephrosclerosis. One patient with poor blood pressure control died from a massive cerebral hemorrhage. Another patient had temporary hemiparesis during good blood pressure control. Thus, in the remainder of this particularly high risk group, strokes, myocardial infarction, and rupture of aneurisms were effectively prevented.