Remembering Dr Marvin Moser

Dr Marvin Moser, one of the leading figures in the field of hypertension, and the first Editor-in-Chief of The Journal of Clinical Hypertension, died on November 13, 2014, at the age of 90. Marvin Moser obtained his MD degree in 1947 from the Downstate Medical College of the State University of New York. He then did residencies in medicine at the Kings County Hospital in Brooklyn and the Montefiore Hospital in the Bronx before undertaking his fellowship in cardiology at the Mount Sinai Hospital in New York. After completing his formal training, Dr Moser served for 2 years as the Chief of Vascular Disease and Hypertension at the Walter Reed Army Medical Center in Washington, DC. For much of his career he was a Clinical Professor of Medicine at the Yale School of Medicine, a post he still held at the time of his death. And in a signal recognition of the outstanding career and public service of its alumnus, Downstate College of Medicine conferred on Dr Moser the honorary degree of Doctor of Science in June 2014. It is remarkable that in the early 1950s, at a time when hypertension was not well understood and, for the most part, untreated by practicing clinicians, the young practitioner Marvin Moser was already identifying himself closely with this discipline. Those were days when most attention was focused on malignant hypertension that was imminently life-threatening. With only a limited selection of antihypertensive drugs, consulting physicians were compelled to consider debilitating procedures such as surgical sympathectomy or strategies such as the temporarily effective but impractical “rice diet.” But Marvin’s natural curiosity and the influence of Dr William Dock, his professor and mentor at Downstate and Kings County Hospital, led him to a belief that hypertension might carry far greater prognostic implications than the immediate risk of major events, and he became one of the first investigators to explore new types of drug therapy for reducing blood pressure. In making his contributions, Marvin had to overcome the nihilistic attitudes of many of the influential experts at that time. Indeed, a common opinion advanced by leading cardiologists in the 1950s and even the early 1960s was that high blood pressure was a compensatory mechanism to overcome obstructive arterial disease and so ensure an adequate blood supply to the brain and other vital organs. Woe betide the clinician foolish enough to place patients at needless risk by reducing their blood pressures! Many years later, Marvin recalled those contentious days in his illuminating monograph: Misconceptions and Heroics––The Story of the Treatment of Hypertension from the 1930s. Those physicians who recognized that even moderately increased blood pressures were predictive of poor cardiovascular outcomes were hampered by the lack of effective and well-tolerated drugs. In fact, it was only in the 1950s and the early 1960s when drugs such as thiazide diuretics and reserpine and other autonomic blocking agents became available that a rational basis for treating hypertension became possible. Even then, skepticism regarding the wisdom of treating hypertension remained. Indeed, this was only resolved when the landmark Veterans Administration studies conducted by Dr Edward Freis and colleagues in the 1960s established the clear cardiovascular and stroke benefits of treating hypertension. Aiding this recognition, of course, were epidemiologic data furnished by research such as the Framingham Study that emphasized the tight and continuous relationship between blood pressure and the risk of cardiovascular and stroke outcomes.