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Updated: June 3, 2025
In pregnancy where there is increased metabolic change, when the proteins are not well or properly cared for in gout, and when there is intestinal fermentation or putrefaction, hypertension is likely to occur. The increased blood pressure in these cases is directly due to irritation of the toxins on the blood vessel walls.
It acts as a diuretic, not only by increasing the circulatory force and blood pressure, but also by acting directly on the kidney. This action on the kidney contraindicates the use of caffein in any form, except in rare instances, when there is acute or chronic nephritis. The increased blood pressure caused by caffein also contraindicates its use when there is hypertension.
The treatment of this disease is successful only in its prevention, and consists in treatment of hypertension before arteriosclerosis is present.
Furthermore, the reason that many infections are followed later by arterio- sclerosis may be the fact that the suprarenals have been stimulated to hypertrophy and hypersecrete. Many persons in middle life, and especially women at the time of the menopause, show hypertension without arterial or kidney reason.
The enumeration of these causes and the causes that have been mentioned before not only suggest, but also direct the treatment of hypertension after it has occurred. The most important of all treatment for hypertension is rest. That means for an individual, well except for his hypertension, a vacation, that is, a rest from physical and mental labor.
Although Lagrange advocated iridectomy in all cases in his first communication, he no longer judges the procedure to be necessary in all instances, reserving it for cases in which for any reason, such as hypertension, prolapse is to be feared.
If the foregoing management does not reduce hypertension, the kidneys are generally beginning to become involved in the sclerotic degeneration, whether the urine shows such a condition or not. On the other hand, there are exceptions to this rule.
Many times such patients, as well as occasionally trained athletes, and sometimes patients with arteriosclerosis or chronic interstitial nephritis complain of unpleasant throbbing sensations of the heart added to these sensations are a feeling of fulness in the head, flushing of the face, and possibly dizziness all symptoms not only of hypertension but of too great cardiac activity.
In this rapid high tension age the physician should be as energetic in teaching prevention of arterial hypertension as he is in preventing contagion. It is therefore the duty of the physician to urge youths and adults to abstain from all kinds of excesses so common in this age. We live at such speed, even the children, that this caution is almost daily needed.
Spirit of glyceryl trinitrate or spirit of Nitroglycerin, dose 1 minim, keeps well if care is taken to guard against evaporation of alcohol; tablets if well made and kept in bottles properly corked, will retain their activity for months. The closer a physician is to the laboratory, the less he believes in the value of nitroglycerin in hypertension.
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