Tomographic study of the congenital dilatation of the pulmonary artery: Adamo Grilli, M.D., and Vittorio Puddu, M.D., Rome, Italy

Abstract

1.1. The blood pressure of the patient with hypertension can be lowered by different dietary methods. These include caloric reduction (controlled or unplanned semistarvation levels), the rice diet of Kempner, and the low-sodium diet. Weight reduction is responsible in part for the lowering of the blood pressure on the diets restricted in calories. The low-sodium content of the rice diet is the “hypotensive” factor since patients on this diet with a normal sodium intake do not have a fall in blood pressure. The low protein content (20 Gm.) of the rice diet is not essential to the lowering effects on the blood pressure, for similar falls in blood pressure have been recorded with a normal protein (70 Gm.) but a low-sodium content.2.2. Reductions of blood pressure to 155100mm. Hg from higher levels were recorded in 24 per cent of 874 patients on either the rice or low-sodium diet. Of these, 212 adequately controlled patients showed a similar reduction in blood pressure in 21 per cent of the instances. To assess the significance of such reductions in blood pressure, one must compare these figures to 18.4 per cent of the patients who had a fall in blood pressure to 150/100 mm. Hg or lower after sympathectomy, even though preoperative blood pressures were in approximately the same range as those treated by the rice or low-sodium diets.Further, spontaneous remissions of the blood pressure during the natural course of hypertension to levels of 14499mm. Hg or below were found by Bechgaard to occur in 2.4 per cent of 709 patients and to normal pressures in 15 per cent of the patients with uncomplicated essential hypertension by Perera.3.3. The mechanism of action of the rice and low-sodium diet has been attributed to the effect of the sodium ion on hypertension as mediated through the adrenals, to an effect of the sodium deprivation on lessening the humoral contribution to maintenance of an increased peripheral resistance, or to the decreased metabolic activities of the kidneys while on the rice diet.4.4. Toxic effects of the rice and low-sodium diets vary from such minor effects as muscular pains to collapse associated with a “low-salt syndrome” and characterized by azotemia and hyponatremia. Nitrogen balance, though negative during the first 2 weeks on the rice diet, reaches essential equilibrium after this.