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To the Editor:—
The article by Russell and Stahl published in The Journal, August 8, does not keep a proper perspective toward the use of thiocyanates in the treatment of essential hypertension. The article failed to emphasize that a patient with hypertension and bad kidneys as evidenced by a urea clearance of 27 per cent of normal, nonprotein nitrogen of 43 mg. per hundred cubic centimeters and 3 plus albuminuria was given the drug, contrary to accepted opinion that this is a dangerous type of case for the use of the drug. The article should also have emphasized even more strongly than the choice of improper case that the drug was continued in unchanged dosage after an excessively high blood level of 15.2 mg. was found. The literature and experience indicate that, when a level above 10-12 mg. occurs, toxicity is around the corner. There is no point in rounding
Ayman D. ESSENTIAL HYPERTENSION. JAMA. 1942;120(2):147-148. doi:10.1001/jama.1942.02830370059023