Essential diastolic hypertension: an investigation into the relative merits of medical and surgical treatment, with a proposed new method of selection for sympathectomy

Abstract

An investigation has been described of which the aim has been two -fold: (a) to compare the result of medical and surgical treatment in two comparable groups of cases of essential diastolic hypertension: (b) to formulate an improved method of selection of cases for surgical treatment.

We have defined the term "essential diastolic hypertension" and dealt with various theories as to the possible etiologv of the condition.

The methods of treatment of the condition, by medical and surgical means, have been described.

The material of the investigation, its character in relation to age, sex, symptoms, duration of history, retinal, cardiac and renal grades and so on, was next described in order to prove that the two groups, medically and surgically treated, were strictly comparable.

The method of arranging the case-material into "matched groups" was next described in order to make clear the manner in which the investigation was converted retrospectively into a carefully controlled experiment.

The results of the two forms of treatment have been reported, showing the difference between the effects of surgical and medical measures on the following items: (a) subjective symptoms and fitness for work; (b) objective phenomena, e.g. basic diastolic pressure, retinal appearance, cardiac and renal function, electrocardiogram and heart -size; (c) the mortality -rate and expectation of life.

The above results were given separately for benign and malignant hypertensive cases, since these two groups were found to present very different problems.

Notes were added as to the effect of lumbo- dorsal sympathectomy on the Cold Pressor and Postural (Tilting Table) tests.

Certain symptoms which were most commonly complained of were then selected for special attention, and the patients *hose leading symptoms they were have been collected together and examined as a special group. These symptoms were (a) head- ;ache; (b) cerebro- ïraseular symptoms, (c) cardiac symptoms, and in each group the effects of surgical and medical treatment were noted; the expectation of life, and the causes of any deaths Which occurred were also analysed.

The various complications and sequelae of lumbo- dorsal sympathectomy have been detailed as they occurred in this investigation.

Finally we have dealt with the selection of cases for sympathectomy, and have described an original method of selection based on statistical correlation of the preliminary tests and investigations with post- operative symptom- grades land diastolic blood pressure levels.