Arterial Hypertension–Thirty-Four Years Ago and Now

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THIRTY-FOUR years ago many clinicians firmly believed that elevated blood pressure should not be lowered lest a reduced perfusion of the kidneys result in uremia. This dictum bequeathed by Cohnheim provided a useful excuse because there was no means available for lowering arterial pressure. Now thirty-four years later, there are many ways and some are quite satisfactory.

The first clue we had, and this is long forgotten, of the harmlessness of blood pressure reduction was that the urea clearance did not change when arterial pressure was lowered by, of all things, colloidal sulfur. The experiment was crude but it did show that an elevated blood pressure was not necessary or “essential,” and that the kidneys possessed a remarkable capacity to readjust to change in perfusion pressure.

Let us hasten to add that we are telling a story of hypertension as two people see it. There are quite evidently other ways.

The next step in our thinking occurred when Dr. E. V. Allen of the Mayo Clinic told one of us that his neurosurgical colleague, Dr. Alfred Adson, had performed an anterior rhizotomy in a hypertensive patient, and the blood pressure had been sharply reduced. Forthwith, at our suggestion, Dr. George Heuer performed such an operation in a patient with malignant hypertension. The reason we selected a patient with the malignant form was that bitter experience showed how hopeless was its prognosis. To our great surprise, the patient survived the “yard-long” laminectomy; retinopathy disappeared; the heart size was reduced; the inverted . . .