Thursday, February 23, 2017

The History of High Blood Pressure

For much of his presidency, Franklin Delano Roosevelt’s blood pressure was high. His doctors knew but didn’t do much.

Doctors had been measuring blood pressure since the 19th century, but they considered it a vital sign – like pulse rate or respiration rate or temperature. They felt better if it was normal but didn’t believe that high pressure was a disease. Everyone knew (as everyone knows today) that stress makes your pressure go up, so avoiding stress was a good idea, but that’s hard for a president. His pressure was spectacularly high the day he died of a stroke in 1945 while relaxing in Georgia.

By the 1950s many doctors believed that high blood pressure was unhealthy. Doctors who act on their beliefs are no different from anyone else. They do a lot of dumb things. So not every doctor treated it.

Proving that high blood pressure kills requires observing thousands of people for years. By the 1960s it was proved. It seems a no-brainer that this means doctors should lower high blood pressure, but that doesn’t follow. After all, a rapid pulse or fever is often an ominous sign, but returning them to normal doesn’t accomplish much.

Proving that reducing high blood pressure saves lives requires observing thousands of people, treated and untreated, for years. By the time I entered medical school in 1968, this had been done, and we heard lectures urging us to treat high blood pressure vigorously.

This was not easy because the drugs available lowered many things beside blood pressure, so they made patients drowsy, dizzy, constipated, and impotent. But things have improved.  

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