Historical Perspectives on the Management of Hypertension

As late as the 1950s, elevated blood pressure was considered by many expert physicians to be necessary for the adequate per fusion 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.The greatest danger to a man with high blood pressure lies in its discovery, because then some fool is certain to try and reduce it. — J.H. Hay, 1931Hypertension may be an important compensatory mechanism which should not be tampered with, even were it certain that we could control it. —Paul Dudley White, 1937