Dangerous Hex

A middle-aged woman walked into the pine-paneled Philadelphia office of Internist Samuel Lowenberg last week and announced firmly: "I have high blood pressure, and I just read about that new drug, and I want to try it." This sort of thing was happening in doctors' offices all over the U.S. Patients who could not get their tongues around the hexasyllabic name of hexamethonium demanded the new drug, and no argument.

Like most doctors in the same spot, Dr. Lowenberg gave his patient the argument but not the drug. Carefully he explained that high blood pressure is not in itself a disease; it is a symptom of an underlying disorder. Unfortunately, in at least 75% of cases, the root cause is unknown. This cause may be a killer, or patients may live for years and die of some disease which has nothing to do with the state of their blood vessels. Because doctors know that emotional strain is often a big factor in the life of such a patient, they try to cheer him up and calm him down.

That is what Dr. Lowenberg did with Mrs. Y. "Actually," he said, "she needed mild psychotherapy in the form of reassurance from me, plus a small dose of barbiturate. In her case, hexamethonium would have done little good and might have done severe damage."

Hexamethonium has been whooped up in the press as a lifesaver. The facts: P: Hexamethonium works by blocking impulses from the nerves which make small blood vessels contract. Thus, it helps the vessels to dilate, gives the blood more room to flow freely at lower pressure. For this purpose it is more effective than other drugs, and is a substitute for the surgical operation of sympathectomy. P: Hexamethonium works quickly, dramatically--and dangerously. An overdose may cause shock, or even death from a stroke or heart attack. It should be given to new patients only in a hospital, and only when their high blood pressure is soaring perilously or their arteries are being rapidly damaged. P: Even where its use is clearly called for, it works in only 20% to 25% of cases.

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