The hypotensive effect of imipramine hydrocloride in patients with cardiovascular disease.

Abstract

The untoward effects of imipramine hydrochloride were studied in a group of 41 patients under 60 years of age who were without demonstrable cardiovascular disease and compared with those in a group of 50 patients with various degrees of generalized or coronary atherosclerosis. Effects on the following were investigated: recumbent and standing blood pressures, pulse, electrocardiograms, blood coagulation (bleeding time, clotting time, prothrombin time), liver function (SGOT, alkaline phosphatase, cephalin flocculation, thymol turbidity), and formed elements in the blood (hemoglobin, white blood cells with differential count, platelets).Among the patients with cardiovascular disease, 4 developed congestive heart failure during imipramine administration, while severe postural hypotension was observed in 10 of 41 (24.4 per cent). Two developed myocardial infarction during a hypotensive period. Moderate hypotension was present in 7 patients (14 per cent). Few significant untoward effects were encountered in the patients without cardiac disease. Severe postural hypotension was not observed; rrwderate degrees occurred in only 3 of the 41 patients (7.3 per cent).It is suggested that extreme caution be practiced in the treatment of depressive states in patients with known cardiovascular disease, especially in the older age group. Imipramine should be given in small doses and discontinued if postural hypotension occurs.