History of hypertension
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The modern history of hypertension begins with the understanding of the
cardiovascular system The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
based on the work of physician William Harvey (1578–1657), who described the circulation of blood in his book ''De motu cordis''. The English clergyman Stephen Hales made the first published measurement of
blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
in 1733. Descriptions of what would come to be called
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
came from, among others, Thomas Young in 1808 and especially Richard Bright in 1836. Bright noted a link between cardiac hypertrophy and kidney disease, and subsequently kidney disease was often termed Bright's disease in this period. In 1850 George Johnson suggested that the thickened blood vessels seen in the kidney in Bright's disease might be an adaptation to elevated blood pressure. William Senhouse Kirkes in 1855 and Ludwig Traube in 1856 also proposed, based on pathological observations, that elevated pressure could account for the association between left ventricular hypertrophy to kidney damage in Bright's disease. Samuel Wilks observed that left ventricular hypertrophy and diseased arteries were not necessarily associated with diseased kidneys, implying that high blood pressure might occur in people with healthy kidneys; however, the first report of elevated blood pressure in a person without evidence of kidney disease was made by
Frederick Akbar Mahomed Frederick Henry Horatio Akbar Mahomed (11 April 1849 – 22 November 1884) was an internationally known British physician from Brighton, England. Family and personal life Frederick Henry Horatio Akbar Mahomed was born on 11 April 1849 in Brig ...
in 1874 using a
sphygmograph The sphygmograph ( ) was a mechanical device used to measure blood pressure in the mid-19th century. It was developed in 1854 by German physiologist Karl von Vierordt (1818–1884). It is considered the first external, non-intrusive device used to ...
. The concept of hypertensive disease as a generalized circulatory disease was taken up by
Sir Clifford Allbutt Sir Thomas Clifford Allbutt (20 July 183622 February 1925) was an English physician best known for his role as president of the British Medical Association 1920, for inventing the clinical thermometer, and for supporting Sir William Osler in fo ...
, who termed the condition "hyperpiesia". However, hypertension as a medical entity really came into being in 1896 with the invention of the cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896, which allowed
blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
to be measured in the clinic. In 1905,
Nikolai Korotkoff Nikolai Sergeyevich Korotkov (also romanized Korotkoff; russian: Никола́й Серге́евич Коротко́в) ( – 14 March 1920) was a Russian Empire surgeon, a pioneer of 20th-century vascular surgery, and the inventor of aus ...
improved the technique by describing the Korotkoff sounds that are heard when the artery is ausculted with a stethoscope while the sphygmomanometer cuff is deflated. Tracking serial blood pressure measurements was further enhanced when Donal Nunn invented an accurate fully automated oscillometric sphygmomanometer device in 1981. The term essential hypertension ('Essentielle Hypertonie') was coined by Eberhard Frank in 1911 to describe elevated blood pressure for which no cause could be found. In 1928, the term malignant hypertension was coined by physicians from the
Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...
to describe a syndrome of very high blood pressure, severe retinopathy and inadequate kidney function which usually resulted in death within a year from
stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
s,
heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...
or kidney failure. A prominent individual with severe hypertension was Franklin D. Roosevelt. However, while the menace of severe or malignant hypertension was well recognised, the risks of more moderate elevations of blood pressure were uncertain and the benefits of treatment doubtful. Consequently, hypertension was often classified into "malignant" and "benign". In 1931, John Hay, Professor of Medicine at Liverpool University, wrote that "there is some truth in the saying that the greatest danger to a man with a high blood pressure lies in its discovery, because then some fool is certain to try and reduce it". This view was echoed in 1937 by US cardiologist Paul Dudley White, who suggested that "hypertension may be an important compensatory mechanism which should not be tampered with, even if we were certain that we could control it". Charles Friedberg's 1949 classic textbook "Diseases of the Heart", stated that "people with 'mild benign' hypertension ... efined as blood pressures up to levels of 210/100 mm Hgnbsp;... need not be treated". However, the tide of medical opinion was turning: it was increasingly recognised in the 1950s that "benign" hypertension was not harmless. Over the next decade increasing evidence accumulated from actuarial reports and longitudinal studies, such as the Framingham Heart Study, that "benign" hypertension increased death and cardiovascular disease, and that these risks increased in a graded manner with increasing blood pressure across the whole spectrum of population blood pressures. Subsequently, the National Institutes of Health also sponsored other population studies, which additionally showed that African Americans had a higher burden of hypertension and its complications. __TOC__


Treatment and medications

Historically the treatment for what was called the "hard pulse disease" consisted in reducing the quantity of blood by
blood letting Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily fl ...
or the application of
leech Leeches are segmented parasitic or predatory worms that comprise the subclass Hirudinea within the phylum Annelida. They are closely related to the oligochaetes, which include the earthworm, and like them have soft, muscular segmented bodie ...
es. This was advocated by The Yellow Emperor of China,
Cornelius Celsus Aulus Cornelius Celsus ( 25 BC 50 AD) was a Roman encyclopaedist, known for his extant medical work, ''De Medicina'', which is believed to be the only surviving section of a much larger encyclopedia. The ''De Medicina'' is a primary source on d ...
, Galen, and Hippocrates. In the late 19th and early to mid 20th centuries, many therapies were used to treat hypertension, but few were effective, and these were poorly tolerated. Therapies used in that period included strict sodium restriction (for example the rice diet),
sympathectomy A sympathectomy is an irreversible procedure during which at least one sympathetic ganglion is removed. One example is the lumbar sympathectomy, which is advised for occlusive arterial disease in which L2 and L3 ganglia along with intervening sym ...
(surgical ablation of parts of the
sympathetic nervous system The sympathetic nervous system (SNS) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of th ...
), and pyrogen therapy (injection of substances that caused a fever, indirectly reducing blood pressure). The first chemical for hypertension,
sodium thiocyanate Sodium thiocyanate (sometimes called sodium sulphocyanide) is the chemical compound with the formula NaSCN. This colorless deliquescent salt is one of the main sources of the thiocyanate anion. As such, it is used as a precursor for the synthes ...
, was used in 1900 but had many side effects and was unpopular. Other treatments, such as
barbiturate Barbiturates are a class of depressant drugs that are chemically derived from barbituric acid. They are effective when used medically as anxiolytics, hypnotics, and anticonvulsants, but have physical and psychological addiction potential as we ...
s, bismuth, and bromides were mainly supportive rather than therapeutic. Other drugs were used after the Second World War, the most popular and reasonably effective of which were
tetramethylammonium chloride Tetramethylammonium chloride is one of the simplest quaternary ammonium salts, with four methyl groups tetrahedrally attached to the central N. The chemical formula (CH3)4N+Cl− is often abbreviated further as Me4N+Cl−. It is a hygroscopic colo ...
and its derivative
hexamethonium Hexamethonium is a non-depolarising ganglionic blocker, a nicotinic ( nAChR) receptor antagonist that acts in autonomic ganglia by binding mostly in or on the nAChR receptor, and not the acetylcholine binding site itself. It does not have a ...
. Also used in the post-war period were hydralazine and
reserpine Reserpine is a drug that is used for the treatment of high blood pressure, usually in combination with a thiazide diuretic or vasodilator. Large clinical trials have shown that combined treatment with reserpine plus a thiazide diuretic reduces m ...
(derived from the medicinal plant ''
Rauvolfia serpentina ''Rauvolfia serpentina'', the Indian snakeroot, devil pepper, or serpentine wood, is a species of flower in the milkweed family Apocynaceae. It is native to the Indian subcontinent and East Asia (from India to Indonesia). ''Rauvolfia'' is a pe ...
''). A major breakthrough was achieved in the 1950s with the discovery of well-tolerated oral diuretics, the first of which was chlorothiazide (Diuril). This was derived from the antibiotic
sulfanilamide Sulfanilamide (also spelled sulphanilamide) is a sulfonamide antibacterial drug. Chemically, it is an organic compound consisting of an aniline derivatized with a sulfonamide group. Powdered sulfanilamide was used by the Allies in World War II ...
and became available in 1958. A randomized controlled trial sponsored by the Veterans Administration comparing hydrochlorothiazide plus reserpine plus hydralazine versus placebo had to be stopped early because those not receiving treatment developed many more complications and it was deemed unethical to withhold treatment from them. The study continued in people with lower blood pressures and showed that treatment even in people with mild hypertension more than halved the risk of cardiovascular death. In 1975, the Lasker Special Public Health Award was awarded to the team that developed chlorothiazide. The results of these studies prompted public health campaigns to increase public awareness of hypertension and promoted the measurement and treatment of high blood pressure. These measures appear to have contributed at least in part to the observed 50% fall in stroke and ischemic heart disease between 1972 and 1994. Soon more drugs became available to treat hypertension. The British physician
James W. Black Sir James Whyte Black (14 June 1924 – 22 March 2010) was a Scottish physician and pharmacologist. Together with Gertrude B. Elion and George H. Hitchings, he shared the Nobel Prize for Medicine in 1988 for pioneering strategies for rational d ...
developed beta blockers in the early 1960s; these were initially used for
angina Angina, also known as angina pectoris, is chest pain or pressure, usually caused by ischemia, insufficient blood flow to the Cardiac muscle, heart muscle (myocardium). It is most commonly a symptom of coronary artery disease. Angina is typical ...
, but turned out to lower blood pressure. Black received the 1976 Lasker Award and in 1988 the Nobel Prize in Physiology or Medicine for his discovery. The next class of antihypertensives to be discovered were
calcium channel blockers Calcium channel blockers (CCB), calcium channel antagonists or calcium antagonists are a group of medications that disrupt the movement of calcium () through calcium channels. Calcium channel blockers are used as antihypertensive drugs, i.e., as ...
. The first member was verapamil, a derivative of papaverine that was initially thought to be a beta blocker and used for angina, but then turned out to have a different mode of action and was shown to lower blood pressure. The renin–angiotensin system was known to play an important role in blood pressure regulation, and angiotensin converting enzyme (ACE) inhibitors were developed through rational drug design. In 1977
captopril Captopril, sold under the brand name Capoten among others, is an ACE inhibitor, angiotensin-converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of congestive heart failure. Captopril was the first oral ACE inh ...
, an orally active agent, was described; this led to the development of a number of other ACE inhibitors. More recently angiotensin receptor blockers and
renin inhibitors Renin inhibitors are pharmaceutical drugs inhibiting the activity of renin that is responsible for hydrolyzing angiotensinogen to angiotensin I, which in turn reduces the formation of angiotensin II that facilitates blood pressure. Renin inhib ...
have also been introduced as antihypertensive agents.


References

{{reflist Hypertension
Hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...