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Hexamethonium was the first orally active drug to treat hypertension. Like all agents in this group it blocks sympathetic and parasympathetic systems alike. Severe side effects have rendered them of historical interest only in hypertension therapy.23

22 Conference on use of tranquillising agent Serpasil in animal and poultry production 1959 College of Agriculture, Rutgers State University, USA. Wild turkeys have a blood pressure of 120/60 mmHg, but domestic turkeys are hypertensive (204/144 mmHg). Digoxin increases the incidence of aneurysm. It seems that it is the rate of rise of pressure in the aorta that is important in this disease (probably in man also) and that reserpine and (3-adrenoceptor blockers benefit by attenuating this.

Trimetaphan, a short-acting agent (given by i.v. infusion, initially at 3-4 mg/min), also has direct vasodilator effect; it is used for producing hypotension to provide a blood-free field during surgery, and can be used for emergency control of hypertension; pressure may be adjusted by tilting the body; it provides 'minute-to-minute' control, when the lack of selectivity is important.

Histamine release during infusion is occasionally a problem.

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