A Clinical Approach to Hypertension

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Abstract
1. A new approach to hypertension is introduced by taking into consideration not only casual blood pressure but also baseline blood pressure, blood pressure lability and cold pressor response. 2. In addition to blood pressure measurements the vascular damage in terms of atherosclerosis and/or retinal arteriosclerosis was also taken into consideration by grouping the patients into four groups: Normal; Arteriosclerosis; Hypertension; Hypertension & superimposed arteriosclerosis. 3. Prior to initiating treatment, at least six casual blood pressures were taken by the technical assistant and the physician, during three different visits. 4. The step method, by starting with thiazides and adding other antihypertensive agents during the subsequent office visits according to response was followed. 5. The patients were followed for a four to seven year period so that a meaningful prognostic and therapeutic evaluation was possible. 6. All patients with pure hypertension and without arteriosclerosis and those with pure arteriosclerosis and without hypertension survived during the period of observation. 7. Twenty-three per cent (12 of 51) of males having hypertension with super-imposed arteriosclerosis died, as compared to only 4% (2 of 54) of females; thus a male to female mortality ratio of about 6:1 was observed. 8. A comparison of the living and deceased males of the mixed group having hypertension and superimposed arteriosclerosis showed that the most significant difference between the two subgroups was a marked exaggeration of diastolic cold pressor response in the deceased as compared to the still living patients. 9. It remains to be seen whether or not in these patients with a marked exaggeration of the diastolic cold pressor response, by using a more vigorous treatment with drugs such as methyldopa, propranolol or guanethidine in relatively high doses, we might be able to reduce mortality and increase survival.