Guanethidine in the Management of Hypertension

To the Editor: Woosley and Nies have provided a very helpful update of the pharmacologic properties of guanethidine (N Engl J Med 295:1053, 1976), but they have not provided an update of its role in the management of hypertension. It is important to note that post-exercise pressures were not measured in the two clinical reports cited by Woosley and Nies.¹² I have monitored the use of guanethidine at Baltimore City Hospital since 1971 and have concluded that, because of stereotyped post-exercise orthostatic hypotension, guanethidine should not be administered to obtain a normal resting blood pressure in any hypertensive patient.