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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