Hypertension

“ That is to say, it is the attempt on the part of the body to equalize the distribution of blood in the body when there is some poison causing constriction of the small arteries. In this sense hypertension is not only essential, but actually life-saving. A heart which is so diseased that it can not respond to the call for increased action by hypertrophy of its fibers, would shortly wear out. The very fact that the heart becomes enlarged and the tension in the arteries becomes high, indicates that in such a heart there was great reserve power. ”

“ Diabetes generally, on the other hand, causes a low blood pressure. Patients with this trouble and with hypertension, and without nephritis, probably have an increased secretion from the suprarenals.
We may sum up the prognosis in hypertension as follows: Hypertension alone is not of unfavorable omen; if it is not readily reduced by ordinary means, it is more serious. If associated with kidney, heart or liver defect, it is most serious. If there are such serious conditions as edema, ascites, lung congestion, cyanosis and great dyspnea, the prognosis is dire. ”

“ It is not an average normal state, but it is normal state for the man who has it in chronic form. Hypertension should be viewed rationally and its proper place in the whole make-up of the patient determined. Hypertension is a relative term. What might be high pressure in a man of sedentary habits who reaches the age of fifty, might not be high pressure in a full blooded formerly athletic man of the same age. Temporary hypertension due to excitement, exercise, etc., must be kept in [107] mind. ”

“ Hence the clinical measuring of the pressure in the brachial artery alone is not sufficient for a diagnosis of arteriosclerosis. A persistent high blood pressure even with normal urinary findings is not a sign of arteriosclerosis. The high tension later may lead to the production of sclerosis of the arteries, but in these cases the kidney may be primarily at fault.
The impression must not be gained that hypertension in [186] itself always constitutes a disease or even a symptom of disease. Hypertension itself is practically always a compensatory process. ”

“ The tendency for hypertension and arteriosclerosis to occur early in life in patients who have suffered some serious acute infection, whether blood poisoning, typhoid fever, or other, shows that in all probability in these acute illnesses the internal secretions are so disturbed that the suprarenal activity is greater than normal, while the thyroid activity may be less than normal, and hypertension is the consequence. ”

“ However, if there is a high systolic and a low diastolic pressure, vasodilators are often contraindicated.
TREATMENT In this rapid high tension age the physician should be as energetic in teaching prevention of arterial hypertension as he is in preventing contagion. As infectious diseases are reduced in frequency, more patients live to die of diseases later in life, and (as previously stated) diseases with hypertension are on the increase. It is therefore the duty of the physician to urge youths and adults to abstain from all kinds of excesses so common in this age. ”

“ I can not help but feel that the diastolic pressure is the most important part of the blood pressure picture. Persistent high diastolic pressure means increased work for the heart, which, if acting for a long time against the high peripheral resistance, must eventually hypertrophy. The arteries become thickened, lose their wonderful elasticity, fibrous tissue is deposited in their walls, and the vicious circle is established which leads to pathologic hypertension.
Blood pressure readings must be intimately mixed with brains in order to be of any great value in diagnosis or prognosis. ”

“ In the beginning the symptoms and signs of this disease are generally those of hypertension, and the treatment and management is that advised in hypertension. If the kidneys show irritation, as manifested by the presence of albumini and casts in the urine, or if they show insufficiency in the twenty-four-hour excretion of one or more salts or other excretory product, the diet and life must be more carefully regulated than advised in hypertension, and the treatment becomes practically that of chronic interstitial nephritis. ”

“ It is much more frequent in men than in women. Its most common cause is hypertension; in fact, hypertension generally precedes it. The most frequent cause of hypertension today is the strenuousness of life, the next most frequent cause being the toxins circulating in the blood from overeating, overdrinking, overuse of tobacco and the overuse of caffein in the form of coffee, tea or caffein drinks. Another common cause of arteriosclerosis occurring too early is the occurrence of some serious infection in a person, typhoid fever and sepsis being most frequent. ”

“ All states of hypertension are accompanied by more or less increase of pulse pressure. In other words the systolic pressure is always increased to greater degree than the diastolic pressure. In studies carried out in the wards and Pathological Laboratory of the Milwaukee County Hospital, Milwaukee, we found that in all of the cases of chronic high blood pressure with resulting high pulse pressure four correlated factors were found. ”

“ It has been made a fetish, a god to fall down before and worship and it has been the means of holding a torch of fear over a patient which has not been lost on the charlatans. Popularization of blood pressure has brought its crop of evils, no one of which has been as fruitful in dollars to unprincipled quacks as hypertension. ”

“ That the thyroid secretion lowers blood pressure in certain forms of hypertension is certain, possibly on account of its iodine content. Some combinations of iodine and thyroid such as the iodothyroidin have been used and have had some measure of success attributed to them.
Hypertension does not always demand active measures for its reduction. Viewed from the physiologic standpoint, hypertension is but the expression of a compensating mechanism which is designed to keep the blood moving through narrowed channels. Heart hypertrophy then is absolutely essential to the maintenance of life. ”

“ A patient with simple hypertension and otherwise well, which means that his diastolic pressure is at least no higher than 110, should have his diet, tobacco, coffee and tea regulated; should have recreation periods one or more times a week, and vacations not too infrequently; should take some brisk purgative once or twice a week, and may receive one or other of the physical treatments for the reduction of blood pressure, whether Turkish baths or electric light baths. If he does not sleep well, there is no hypnotic drug so valuable in his case as chloral. ”

“ Hypertension is generally a prelude to arteriosclerosis, and everything which tends to increase tension promotes the disease; everything which tends to diminish tension more or less inhibits the disease. Therefore a subsecretion of the thyroid predisposes to arteriosclerosis, and increased secretion of the suprarenals predisposes to arteriosclerosis, the thyroid furnishing vasodilator substance and the suprarenals vasopressor substance to the blood. ”

“ Excessive use of alcohol, while tending to promote hypertension by the disturbances that it causes, may give, by causing a weak heart muscle, a permanent low blood pressure. A single large dose of alcohol always lowers the blood pressure.
Arteriosclerosis frequently reaches a stage when the blood pressure is low, and with atheroma of the arteries of the arms a true blood pressure is difficult to obtain. Addison's disease, or any other organic lesion of the suprarenals, will lower the pressure, while stimulation of the suprarenals increases the pressure. ”

“ In obese patients with hypertension, in the hypertension of women at the menopause, and in hypertension with insufficient kidneys, thyroid medication is often of great value. Sometimes a small dose of from 0.1 to 0.2 gm. (1 1/12 to 3 grains) once a day is all that is needed. At other times, especially when there is no marked arteriosclerosis and no marked kidney or liver lesion, very high blood pressures are reduced only by very large doses, even as much as 10 grains a day. Such treatment is often of very great benefit. ”

“ While hypertension is not a disease, and while it often should not be combated, still, as it is always the forerunner of more serious trouble, there can be no excuse for not most seriously considering it and generally attempting its reduction. At the moment high tension is discovered, there may be no special symptoms; but troublesome symptoms are always pending, and while the patient need not be unduly alarmed, there is no excuse for not rearranging the individual's life so as to prolong it. ”

“ After a period which may be termed the normal period of hypertension in normal life, as age advances the systolic tension may lower, provided there is no kidney lesion. This is due to the slowly developing chronic myocarditis and a lessening of the tension and therefore lessening of the resistance to the heart. This may be nature's method of lengthening the life of the individual. In other words, as the arteries grow older the force of the heart slightly lessens, the blood pressure lowers, and the individual is safer. ”

“ Lead may be a cause of increased blood pressure, and diabetics occasionally have a high pressure, although more frequently there is a lowering of blood pressure in diabetes.
Richman believes that syphilis is the most common cause of hypertension and arteriosclerosis without renal disease. When arteriosclerosis and renal disease are combined, of course the highest systolic readings occur. He thinks that when high tension occurs under 40 years of age, kidney disease is generally the cause. ”

“ There can be no doubt but that the constant overloading of the stomach with rich or difficultly digestible food is responsible for a large number of cases of arteriosclerosis. Every one must have noted the increase in force and volume of the heart beat after the ingestion of a large meal. The constant repetition of such processes conceivably can lead to damage to the vessel walls through hypertension.
In the metabolism of food in the intestines there are substances produced which are poisonous when absorbed directly into the circulation. ”

“ This is not to state that every high tension must be lowered, but every hypertension must be studied and a safer systolic pressure caused if it is possible without interfering with the person's efficiency. A high diastolic pressure, one above 105, certainly must receive immediate attention, and a diastolic pressure of 110 must be lowered, if possible. ”

“ This is especially true with beginning hypertension, and may be true in young men who are athletic or who are oversmoking but are not being poisoned by the nicotin, as shown by the fact that their hearts are not rapid, that they are not having cardiac pains, that they do not perspire profusely, and that they do not have muscle cramps. A pulse of from 50 to 55 is likely to be seriously considered by an insurance company in deciding the advisability of the risk, and below 50 must be considered as abnormal. ”

“ Some chronic diseases cause a slow pulse; this is especially true of chronic interstitial nephritis. In fact, it may be stated that any disease or condition which increases the blood pressure generally slows the pulse, unless the heart itself is affected. This is true of hypertension, of arteriosclerosis, of nicotin unless the heart has become injured, and often of caffein, unless it acts in the individual as a nervous stimulant. Chronic lead poisoning causes a slow pulse on account of the increased blood pressure. ”

“ Patients suffering from the association of chronic nephritis with hypertension die slowly, usually. There is gradual development of anasarca. Headache is frequent and severe. Pains all over the body may occur. ”

“ After careful inspection has given all the data which it is possible to obtain, one next lays the palm of the hand over the heart and attempts to palpate the apex beat. The thrust of the apex in a hypertrophied heart can readily be felt, and one can feel whether the heart is regular, irregular, intermittent, or has other change in rhythm. The shock of the closing valves, particularly the aortic, can be felt, and that and the forcible apical impulse are very suggestive signs of hypertrophy and hypertension. ”

“ Lead, tobacco, and according to some, tea and coffee, are to be classed as causal factors in the production of arteriosclerosis. Certain it is that all these substances have a tendency to raise the arterial pressure, but whether the drug itself causes first a degeneration, and later a hypertension results, or vice versa, is not yet positively known. We have just mentioned that lead particularly has a marked effect in producing arterial lesions. Other drugs as adrenalin, barium chloride, physostigmin, etc., while producing experimental arteriosclerosis, hardly could produce the disease in man. ”

“ Return to normal pressure is commonly found in those who are cured. Continuation of hypotension seems never to accompany improvement. Prognosis can as safely be based on the alteration in the blood pressure as on changes in the pulse or temperature...."
There are a few drugs which lower the blood pressure, [120] but, as a rule, their effects are more or less transitory. We know of no drug, unless it be iodide of potassium, which has the property of causing changes in the blood (decrease in viscosity?) , which tends to reduce the blood pressure when it is excessive. ”