Alberto Zanchetti

Abstract

Global leader in hypertension research. He was born in Parma, Italy, on July 27, 1926, and died of a brain haemorrhage in Milan, Italy, on March 24, 2018, aged 91 years. Alberto Zanchetti was a respected and globally acknowledged authority on the pathophysiology, clinical pharmacology, and treatment of arterial hypertension. But that simple statement of expertise does little to convey Zanchetti's standing in the field to which he devoted his whole life. “He was a huge figure in hypertension”, says Neil Poulter, Professor of Preventive Cardiovascular Medicine at the UK's Imperial College London, and President of the International Society of Hypertension (ISH). “Was there ever a bigger one?” he asks, rhetorically. “I don't think so.” Poulter's view is echoed by Professor Lars Lindholm of the Department of Public Health and Clinical Medicine at Umeå University in Sweden, and a past President of the ISH. “He was the emperor. There's been no one in modern times to compare with him.” Zanchetti was an example of intellectual inheritance in medical research. In 1951, with a degree in medicine from the University of Parma, he joined the University of Pisa as an assistant professor in its Institute of Physiology where he worked under neurophysiologist Giuseppe Morruzzi on interconnections within the nervous system. In 1956, he moved to the University of Siena's Institute of Internal Medicine to work with Cesare Bartorelli from whom he acquired his interest in hypertension research. It was Zanchetti's experience in neurophysiology that determined the nature of his initial interest in hypertension. As Zanchetti's close colleague Giuseppe Mancia, Emeritus Professor of Medicine at the University of Milano-Bicocca in Milan, Italy, says, “He made a lot of observations on the neural control of the circulation…Some of the first observations on reflex control by the baroreceptors and chemoreceptors were made in Siena. And so were the first observations on the mechanism of blood pressure reduction during sleep.” The effect on Zanchetti of the intermingling influences of his two key mentors shaped the direction his career. As Mancia reflects, “I can't think of anyone else who was so involved in basic research, pathophysiological research in animals and humans…and then clinical research where he became one of the most important people in designing and conducting many trials.” Zanchetti, in his turn, has shaped the lives of others. As Poulter comments, “His mentoring has produced a stable of Italian researchers who've been extraordinarily productive and made huge contributions.” In 1967, Zanchetti joined the University of Milan, becoming Professor of Internal Medicine in 1975. 10 years later he was appointed Scientific Director of the Istituto Auxologico Italiano, an appointment he held until the died. Over the years his studies of hypertension ranged widely throughout the field. Along with Mancia and others, he explored the insights to be gleaned through the use of ambulatory blood pressure monitoring. In addition to studying its fluctuations around the clock he also devised one of the first direct demonstrations of the white coat effect in hypertension. At various times he investigated practically all the classes of antihypertensive drugs, and was a principal investigator or member of the steering group of many of the randomised trials that have revealed the beneficial effects of therapy. He was a consultant to WHO on hypertension from 1978 onwards, and among the authors of two of its major reports on the condition. Lindholm is exaggerating only slightly when he says that “Zanchetti more or less wrote all the hypertension guidelines”. Research was not the only area in which Zanchetti made an impact. He served terms as the President of the European Society of Hypertension and of the ISH. “He was an outstanding Editor-in-Chief of the Journal of Hypertension”, says Lindholm. It was a role he continued to fulfil almost until his death. Mancia says that Zanchetti “lived and breathed his subject. He was totally involved with the whole thing”. Like everyone else who knew Zanchetti, Mancia was amazed by his depth of knowledge. “He was a hard worker with a prodigious memory. You could never win with him when trying to remember the details of a paper”, he says. And there was breadth as well as depth. Zanchetti's knowledge extended beyond science and medicine and into the arts, opera in particular. “I don't think I've ever met anyone who was quite so eclectic in his interests”, Mancia concludes. Zanchetti leaves his daughter, Sylvia, and two sons, Mario and Giorgio.