Medical Management of Hypertension

DR. DOLILERY, Moderator: The symposium this afternoon is on the medical management of hypertension, and most of us would agree that this covers the great majority of cases of hypertension. We are to have three short papers and then a discussion. The first speaker is Dr. Mitchell Perry, of St. Louis, and he will speak on "Etiology and Natural History of Hypertension." DR. PERRY: Diastolic hypertension is a common disease, but exactly how common depends on how it is defined. Although precise definitions are essential to any comprehensive treatment of either the etiology or the natural history of hypertension, I shall neglect them, since they are not vital to the several points that I want to make. Diastolic hypertension is considered to have multiple etiologies. Neurogenic, endocrine, and renal are the adjectives frequently used to describe them; but the justification for these terms is usually scanty at best. For instance, neurogenic hypertension is often stated to be the commonest type of hypertension, yet only in a few rare situations, such as in association with a brain tumor or following bulbar poliomyelitis, is there any real reason to implicate the nervous system. Endocrine hypertension is also considered common, yet the endocrine abnormalitv remains ill-defined except for rare diseases like pheochromocytoma, Cushing's syndrome, and primary aldosteronism. Renal hypertension is perhaps better understood, but I shall leave