Until approximately a decade ago a sympathetic blocking agent was little more than a scientific curiosity but today the picture has been con siderably altered; certain sympathetic blocking chemicals have come into their own as valuable therapeutic agents. They have become available to us through the fine cooperation of our research scientists, a group which includes the chemist, the biologist, and the clinical investigator. In the development of these important drugs as available to physicians today is the pharmacologist who early recognized, with the inquisitive clinician, the important role that sympathetic predominance plays in the symptomatology of certain disorders which reflect imbalance of the autonomic nervous system. Some of these include neurogenic hypertension, certain peripheral vascular diseases, especially Raynaud's and probably Buerger's disease, herpes zoster, hyperthyroidism, tachycardia, glaucoma, exophthalmia, migraine headaches (spastic type), neurodermatoses, renal hypertension (in part neurogenic in origin?), vasospastic dysmenorrhea, causalgia, and probably some types of epilepsy. There is little doubt today that the autonomic nervous system plays a very important role, either directly or indirectly in many diseases, in terms of overactivity or underactivity of either portion of the autonomic nervous system, that is, of the parasympathetic or the sympathetic divisions. Our attention at the moment is directed toward suppressing, within desirable physiologic limits, the overactivity of the sympathetic portion of this system in certain undesirable conditions. This goal can be achieved by cer tain recently developed chemical compounds which have already established their value as therapeutic agents. Inspection of Fig. 1, a diagram by Hafkenschie1 & Sellers (1), which is an excellent modification of that previously employed (2), reveals various focal points of attack in the establishing of sympathetic or adrenergic blockade. The synonymous or interchanging use of the terms sympathetic and adrener gic blockade, a procedure which will be followed throughout this presentation should be noted. Adrenergic refers to that portion of the autonomic nervous system, namely the sympathetic portion, which responds to the action of adrenaline or adrenaline-like substances. These include epinephrine and norepinephrine in particular; any agent that blocks these substances which act in the region of the final arborization or distribution of sympathetic nerve fibers, that is, within the receptive substance of the end organs asso ciated with sympathetic innervation, is classified as a sympathetic or adrenergic blocking agent. On the other hand, one must bear in mind that
Read full abstract