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By A. M. Davison (Auth.)

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B y rapid infusion (5 m i n . ) . 5. v. infusion. 6. m. n. It is best t o b e c o m e familiar w i t h several of these drugs as n o t all cases will be c o n t r o l l e d by t h e use of o n e p r e p a r a t i o n . T h e prognosis in malignant h y p e r t e n s i o n is p o o r n o t only because of t h e underlying cause of t h e h y p e r t e n s i o n b u t because of t h e c o n s e q u e n c e s o n b l o o d vessels. Most p a t i e n t s die from either renal or cardiac failure. T h e r e is also an increased incidence of cerebral c o m p l i c a t i o n s a n d t h e rarer o c c u r r e n c e of retinal a t r o p h y .

2. V. injection of 10 m g over 2 min. A positive test is indicated b y a r e d u c t i o n in systolic pressure of at least 20 m m H g a n d a r e d u c t i o n in diastolic pressure of 10 mgHg. T h e e x a c t place of this test in t h e investigation of t h e h y p e r t e n s i v e p a t i e n t is n o t established and it is n o t invariably positive in cases of r e n i n - i n d u c e d h y p e r t e n s i o n . Clearly it requires detailed evaluation. RENAL ARTERY STENOSIS In renovascular disease a p p r o x i m a t e l y 7 0 per c e n t of p a t i e n t s have uni­ lateral a n d 30 per c e n t bilateral disease.

Malignancy Carcinoma stomach C a r c i n o m a breast Choriocarcinoma Multiple m y e l o m a H o d g k i n ' s disease 6. Renal Vein Thrombosis 7. Congenital and Familial {see p. 53) Conditions M a n a g e m e n t T h e m a n a g e m e n t of t h e p a t i e n t should be aimed at: 1. S y m p t o m a t i c relief of o e d e m a . a. Diet. A high p r o t e i n i n t a k e of 1 5 - 2 0 g / k g / d a y w i t h a restricted sodium i n t a k e , less t h a n 30 m m o l / d a y if possible. •Indicates most c o m m o n age at presentation.

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