Historical Perspectives on the Management of Hypertension

Abstract

As late as the 1950s, elevated blood pressure was considered by many expert physicians to be necessary for the adequate perfusion of vital organs. Although the morbidity and mortality risks of hypertension were known at that time to insurance companies, which often refused life insurance policies to people with high blood pressure, there was a lag in the recognition of the dangers of hypertension in the medical community. Following the pioneering efforts of researchers who began to treat patients with malignant hypertension, the results of clinical trials and population studies, and the availability of effective antihypertensive agents, hypertension management improved rapidly. This review traces the history of hypertension management from the 1940s, when President Franklin Delano Roosevelt died of a cerebrovascular accident-a result of uncontrolled hypertension-to today, when a large number of patients, even those with less severe hypertension, are being treated successfully, with a resulting dramatic decrease in hypertension-related vascular disease.

All Thiazide‐Like Diuretics Are Not Chlorthalidone: Putting the ACCOMPLISH Study Into Perspective

“…4,5 On the surface, the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) trial appears to address the latter question. 6 But in attempting to answer the question, an equally intriguing question has reemerged: ''Is a thiazide diuretic a thiazide diuretic?'…”

Cardiovascular risk factors in elderly : With special emphasis on atrial fibrillation, hypertension and diabetes

“…Some practitioners accepted and valued the use of the sphygmanometer when it was introduced in the late 1800s and early 1900s, but many clinicians were initially sceptical claiming that 'we pauperize our senses and weaken clinical acuity' [28]. In the 1920s it was found that 'mortality increases rapidly with the increase in blood pressure over the average' [28] [32] . In the 1940s surgical sympathectomies and adrenal-ectomies were performed to treat malignant hypertension, the latter with a surgically induced Mb Addison as a side effect [30].…”

“…The medical community was sceptical to antihypertensive treatment initially, and several well-known cardiologists advised against antihypertensive treatment in the 1930s [28]. The first antihypertensive agents were nitrates and thiocyanates among others and thiazide-type diuretics and spironolactone were discovered in the late 1950s [28,32]. In the 1960s and 1970s, many experts still believed that hypertension was a natural process of ageing, and that the normal systolic blood pressure (SBP) level was 'age + 100'.…”

“…The Framingham Heart Study, begun in 1949, reported in the 1960s that there was a strong correlation between hypertension and cardiovascular endpoints; myocardial attacks, stroke and congestive heart failure (CHF) [33]. Almost every large clinical trial has shown that the lower the BP, blood pressure, the better the outcome and today's management of hypertension is a major success in preventive medicine [32].…”

Utilizing proteomics to understand and define hypertension: where are we and where do we go?

“…Where the potential harmful consequences of high blood pressure have not been generally accepted up until less than 100 years ago [5], the association between high blood pressure cardiovascular damage and reduced lifespan became apparent with the availability of large epidemiological data, such as the Framingham Heart Study [6]. Definitions of hypertension have been based on systolic, diastolic or both pressures and have generally seen a higher cut-off in the past and much lower thresholds in more recent years.…”