Brief Reviews : Arterial Hypertension in Retrospect

• Current theories of arterial hypertension have a relatively short history and are still undergoing drastic revision. The purpose of this very brief retrospective review is to show how great the changes in theory have been since we wrote "A Guide to the Theory of Arterial Hypertension" (1) 15 years ago and to highlight some of my many biases. Documentation is spotty and far from comprehensive, it fails to confer priority ratings, and it reflects my age. The review is chiefly directed at young investigators as a reminder that they have an intellectual past, often worth knowing. Bright (1827), Gull and Sutton (1872), Mahomed (1879), Huchard (1889), and Albutt (1895) laid some sound clinical groundwork in the field of arterial hypertension, but they also sowed etiologic confusion. Many clinicians believed, for instance, that elevated blood pressure forced blood through thickened arteries and arterioles, thus ensuring adequate perfusion of tissues. Consequently, they thought that the reduction of blood pressure could only be detrimental. With the modern era, several fundamental problems arose. (1) Did cardiovascular disease precede or follow the occurrence of hypertension? (2) Was the rise in blood pressure in essential hypertension due to a single cause? (3) If so, was the kidney, the nervous system, the endocrine system, or the hemodynamic changes in the heart and blood vessels the stimulus for the rise in blood pressure? (4) Was lowering blood pressure harmful or desirable? (5) What were the exact sequences of hemodynamic change which resulted in chronic hypertension? It is around all these fundamental questions that the extraordinarily productive work of the past four decades has circled.