Analysis of 177 cases of hypertensive vascular disease with papilledema: One hundred twenty-six patients treated with rice diet

Abstract

One hundred seventy-seven patients with hypertensive vascular disease with papilledema (confirmed by eyeground photographs) were seen between October, 1942, and October, 1953. In six patients follow-up information is inadequate or the treatment period too short for evaluation. In thirty-three patients with hypertensive neuroretinopathy who were willing to be treated with the rice diet, electrolyte imbalance developed within the first three months on the rice diet. Treatment with drastic salt restriction therefore could not be carried out, but additional NaCl or other chloride was given. In thirty-one of these thirty-three patients the total PSP excretion in two hours was below 36 per cent. All thirty-three patients died. In eighteen patients treatment with the rice diet was not carried out at any time; only one of these is still living. In 120 patients with hypertensive neuroretinopathy treatment with the rice diet was carried out. The period of treatment was from 1 to 117 months. In 83 of the 120 patients the total PSP excretion in two hours was below 55 per cent. (This includes four patients in the terminal stage of the disease, in whom the PSP was not measured.) Forty-seven (57 per cent) of these patients survived one year; twenty-six (31 per cent) are still living four and one-fourth years (average) after treatment was started. In thirty-seven patients the total PSP excretion was 56 per cent or more in two hours; thirty-four (92 per cent) survived one year; twenty-six (70 per cent) are still living five years (average) after treatment was started. One hundred of the 120 patients were followed after the initial period of the treatment with the rice diet, and in these patients the relation of the length of time of supervised treatment to the survival time could be studied. In 39 of the 100 patients the period of supervised treatment was two to twelve months. Seven of the thirty-nine died during this period while presumably still following the diet; only three of the seven were following it correctly. Thirty-two of the thirty-nine were treated for two to twelve months, and then to a greater or lesser extent discontinued the treatment; only six (19 per cent) of the thirty-two are still living. Eighteen of the 100 patients were treated one to seven and one-half, average three, years and then to a greater or lesser extent discontinued the treatment. Nine of these (50 per cent) are still living. Forty-three of the 100 patients were treated over one year with the rice diet and continued treatment. Thirty-seven (86 per cent) of these are still living; of the six who died, only three were following the diet correctly. The effect of the rice diet on retinopathy was studied in 100 patients in whom eyeground photographs were available. In ninety-two of the 100 patients, papilledema disappeared completely. The effects of the rice diet on blood pressure, serum cholesterol, blood non-protein nitrogen, T 1 in the electrocardiogram, cardiothoracic ratio and renal function were studied in sixty-one patients who were re-examined here at least one year after treatment had been started. A comparison of the findings before treatment, during the period of “strictest adherence to the rice diet” and at the most recent examination shows that the “strictest adherence to the rice diet” produces the most favorable results. Dietary modifications therefore should be made gradually and with careful observations of blood pressure readings, blood chemical findings, electrocardiograms, chest films, eyeground photographs, etc. The results are interpreted as indicating that intensive dietary treatment should be started as early as possible and continued until all signs of the vascular disease have disappeared.