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• Survivors of myocardial infarction who have been discharged from the hospital face an increasing cumulative risk of suffering another infarction or death. β-Adrenergic blocking agents have undergone various trials to reduce these risks and prolong life. Although earlier trials have shown conflicting results, recent studies have conclusively demonstrated the beneficial role of this class of drugs in reducing the chances of recurrent infarction and death. These studies are briefly reviewed and appropriate conclusions as well as recommendations are made. ( Arch Intern Med 1983;143:1759-1762)

Nitrate administration is sometimes associated with mild hypotension, but serious side effects are uncommon. Recently, we have seen four patients who have demonstrated life-threatening hypotension and bradycardia after nitroglycerin administration. This observation, which has also been noted previously,3gives grounds for caution in the administration of nitroglycerin. The efficacy of nitrates is attributed to their vasodilator effects, especially their peripheral venodilating properties. A decrease in venous return and, to a certain extent, in arteriolar resistance usually causes hypotension of variable degrees. This hypotension leads to baroreceptor-mediated reflex stimulation of the vasomotor center. In turn, vascular tone and heart rate both increase, helping to support the blood pressure. Thus, for tachycardia to emerge in response to hypotension, it is necessary to have both an intact reflex mechanism and adequate sinus node function. Conditions that impair the baroreceptor reflex mechanism or sinus node function should lead to an inadequate increase in

• Aprindine hydrochloride has been extensively used in Europe for the management of ventricular and supraventricular arrhythmias. Success has been achieved even in those cases that have proven refractory to standard antiarrhythmic agents. In this report, we describe our experience with aprindine therapy in seven patients with ventricular tachycardia in whom standard antiarrhythmic agents had proven either ineffective or had caused intolerable side effects. Aprindine was effective in five cases, and it failed in two. Neurologic side effects, although common, were easily controlled with adjustment of the dose. Agranulocytosis, a rare but serious side effect, was encountered in one of our patients. Relevant literature on aprindine is reviewed. ( Arch Intern Med 1983;143:229-232)