Diazoxide

To the Editor:

Regional variation in medical practice gets a lot of press. I first read about the use of diazoxide and trimethaphan in hypertensive emergencies as a medical student in the late 1970s and most recently in CHEST (July 2000).[1] Yet for [is greater than] 2 decades of practice in at least a half-dozen Southern California hospitals, I have never seen either agent used. This may be a parochial view, but it seems hazardous to recommend drugs with which ICU staffs have little or no familiarity. I am reminded of the old saw, "Be neither the first nor the last to use a drug."

Gerard W. Frank, MD Los Angeles, California

Correspondence to: Gerard W. Frank, MD, 1701 Cesar Chavez Ave, Suite 100, Los Angeles, CA 90033

REFERENCE

[1] Varon J, Marik PE. The diagnosis and management of hypertensive crisis. Chest 2000; 118:214-227

To the Editor:

We appreciate Dr. Frank's comments regarding the use of diazoxide and trimethaphan in our review of hypertensive crises in CHEST.[1] It is true that regional variations exist in the use of antihypertensive agents. The pharmacopeia of individual hospitals are clearly different, and we must understand that the readership of CHEST is quite diverse, including physicians from around the world. Drugs like trimethaphan and diazoxide have been supplanted by other agents in most areas of the United States. However, these agents remain available here and around the world. A review of hypertensive crises would be incomplete without mentioning these treatment alternatives.

Joseph Varon, MD, FCCP Robert E. Fromm, Jr, MD, FCCP Baylor College of Medicine Houston, Texas

Paul E. Marik, MD, FCCP Washington Hospital Center Washington, DC

Correspondence to: Joseph Varon, MD, FCCP, Dept. of Emergency Services, The Methodist Hospital, 6565 Fannin, MS M196, Houston, TX 77030; e-mail: jvaron@bcm.tmc.edu

REFERENCE

[1] Varon J, Marik PE. The diagnosis and management of hypertensive crises. Chest 2000; 118:214-227

COPYRIGHT 2001 American College of Chest Physicians
COPYRIGHT 2001 Gale Group