[Problems in hypertension therapy in patients with a constant frequency pacemaker]

Patients wtih pacemakers with constant frequency must cope with their problems of the regulation of the circulation without having the possibility of changing the heart rate. These are not inconsiderable under everyday conditions, e.g. in the orthostatic experiment. A large number of medicaments with coronary and antihypertensive effects disturbs the periphery of the circulation as the possibility of regulation which persist in the patients with pacemakers. On the basis of orthostatic experiments on patients with pacemakers with constant frequency the acute effect of drugs, such as nitroglycerin, trapidil, dihydroergotoxin and aminophyllin as well as the long-term effect of antihypertensive drugs concerning the disturbances of the orthostatic regulation is dealt with. The acute effect especially of nitroglycerin is clinically relevant. Concerning the permanent therapy with antihypertensive drugs, there exists probably a possibility of adaptation. In oral application Rauwolfia alkaloids and clonidin do not show a disadvantageous influence on the orthostatic behaviour.