Treatment of hypertension: A 23-Year follow-up of 453 patients with a selected review and report of current experience

Abstract

This is the fourth and final report on 453 patients with hypertension, followed for 23 years, 17 years since closing the series to additional patients. Percentage survivals over the years are shown, demonstrating- the usefulness of the original classification according to severity: Grade I = mild to Grade III = severe, and Grade IV = malignant. Cardiovascular renal disease is the cause of death in 75 to 90 per cent (as compared to 50 per cent for the general population) and appears earlier in life with each rise in grade. It is safe, cheap, and often possible to control the blood pressure level bydiet plus phenobarbital in Grades I and II and sometimes possible in Grade III. Drugs are easy to prescribe and are far more easily accepted by the patient than is restriction in diet. Rauwolfia serpentina and its fractions or derivatives are slightly, if at all, more effective than phenobarbital and have more side effects. The chief use of Rauwolfia is as a tranquilizer, rendering acceptable more rigorous drug treatment. Chlorothiazide is a substitute for salt restriction; the bulk of the evidence indicates that its mode of action is diuretic, depleting the body of salt and water. The effect of years of use on the kidneys and other organs and tissues awaits further observation. This drug may cause a rise in uric acid and muscle and joint pains. Use of small doses is effective and recommended, combined with small doses of ganglionic blocking drugs in Grade III patients with actual or threatened congestive heart failure, and used alone in less severe grades with high blood pressure levels. Grade IV, clinically malignant hypertension with papilledema, requires every resource of diet and drugs to control the blood pressure level which by itself in this condition is rapidly fatal. The ease with which the blood pressure level is observed and, in recent years, the ease with which it is effectively treated by a multitude of hypotensive drugs have misled many practitioners, and those who have presumed to teach them, to neglect the equally important therapeutic problem of patients with hypertension and also of the general population, namely, degenerative vascular disease. Patients with hypertension differ from nonhypertensives only by having it oftener and sooner. Degenerative vascular disease is related to age, hypertension, and unknown factors, as well as to ingested animal fat—the latter fact having been known for 50 years. Evidence is presented that a basic treatment of all patients with hypertension is a low salt, low animal fat diet.