The Story of the Silent Killer
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INVITED COMMENTARY
The Story of the Silent Killer A History of Hypertension: Its Discovery, Diagnosis, Treatment, and Debates Jonathan P. Kalehoff 1 & Suzanne Oparil 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Hypertension is the leading risk factor for death and disability-adjusted life-years lost globally. Despite this tremendous impact on health, blood pressure measurement and treatment are relatively new to medical practice, with widespread measurement beginning just over 100 years ago. How, in such a short time, did blood pressure become such an integral measurement in medical practice that it is now considered one of the vital signs? Key revelations through Stephen Hales and his horse experiment, RivaRocci’s modern blood pressure cuff, Korotkoff sounds, and President Roosevelt’s death set the stage for discovery. Landmark trials such as the VA Cooperative studies of the 1960s through the recent Systolic Blood Pressure Intervention Trial and Prevention with Mediterranean Diet trials provide the foundation for modern clinical practice. An understanding of the history of hypertension can directly affect current clinical practice and offers unique insights into how the medical community has approached the management of one of the deadliest medical conditions in history. Keywords Hypertension history . Antihypertensive medication development . Sphygmomanometer . Oscillometry . Korotkoff . Hypertension trials . Blood pressure goals
Introduction Hypertension (HTN), or elevated blood pressure (BP), is one of the most common medical diagnoses in the world and was the leading risk factor, among 84 studied, for death and disability-adjusted life-years lost between 1990 and 2017 according to the Global Burden of Disease Study [1, 2]. HTN contributes to over 10.4 million deaths annually worldwide [1, 3]. More than 116 million Americans above the age of 20 years, or 46% of the US population, have the diagnosis which directly contributes to over 82,000 deaths annually [4]. When left uncontrolled, HTN contributes to the development of highly prevalent debilitating diseases, including heart * Jonathan P. Kalehoff [email protected] 1
Tinsley Harrison Internal Medicine Residency Program, Division of Internal Medicine, Department of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
2
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, School of Medicine,, The University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, Birmingham, AL 35294-0007, USA
disease, chronic kidney disease, and stroke [5]. Not only is HTN associated with high rates of morbidity and mortality, it also has had devastating economic impact worldwide [6]. Despite the tremendous impact of HTN on health, BP measurement and treatment are relatively new to medical practice, with widespread measurement beginning just over 100 years ago and widespread treatment just over 60 years ago. For thousands of years, temperature, heart rate, and
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