MORE ON DANGEROUS ANTIHYPERTENSIVE THERAPY

A case of temporary blindness due to rapid lowering of blood pressure A further case is reported of visual loss due to 'overzealous' antihypertensive therapy [see also Inpharma 200: 4 (I8 Aug /979)]. A 24-year-old woman with sinus tachycardia 120 beats 1 min, BP 3001 200mm Hg, haematuria and blurred vision was given diazoxide 300mg IV, twice with a I-hour interval, and frusemide (furosemide). Her BP dropped then rose again. Sodium nitroprusside infusion for 8 hours reduced her BP to 120/80mm Hg and this was followed by atenolol I OOmg bid + diuretics. Ten hours later, with a BP II 0/75mm Hg she had sinus bradycardia and total visual loss . A 25 % mannitol infusion restored some vision but this was lost again as the BP dropped to 90/ 60mm Hg. Dexamethasone was added to the mannitol and after 24 hours sight was recovered and her BP was 1801 130mm Hg. The temporary blindness appears to be caused by an imbalance between low perfusion pressure to the eye and the intraocular pressure. A lowering of the intraocular pressure with IV mannitol or acetazolamide might be considered, since visual loss for over

24 hours could well be permanent. Jonasson. F. : British Medical Journal 2: 1218 (\ 0 Nov 1979)

0156-2703/79/ 1124-0007 $00.50/ 0 © ADIS Press INPHARMA 24 Nov 1979 7