For most of the 20th century, if a 70-year-old patient walked into his doctor’s office and the blood pressure monitor showed 170 mmHg systolic (known as a “high”), the doctor would slap him and send him home to have perfect blood pressure. Nowadays, these figures set off all possible alarms in a query, and this shift in ‘reference’ has a meaning in history.
It’s understandable. In those years, the rule stated that normal blood pressure should be calculated by adding 100 to the patient’s age. And it was done this way because it was considered a natural process that the heart had to pump blood harder to reach the aging arteries. Today we know that this belief costs millions of lives.
A famous case. If there is an important person on our planet, it is the President of the United States, and obviously every effort is made to maintain his perfect health (and secrecy). That is why, to understand the seriousness of this medical blindness, we have to go back to the history of President Franklin D. Roosevelt.
And this is no surprise, because in 1932 the blood pressure of the President of the United States was 140/100, but between 1935 and 1941 these increased to 188/105. Statistics that we know today can be deadly for the cardiovascular system.
Answer. Although now we have hypertensives, at that time the medical response was non-existent. And her doctor, surprisingly, was an otorhinolaryngologist who did not consider these figures to be a clinical problem to treat. Something quite common, as seen decades later when cardiologist Franz H. Messerli explained to the magazine New England At the time the medical community viewed high blood pressure as a physiological phenomenon.
But the result here was disastrous, as Roosevelt died of a massive cerebral hemorrhage in April 1945. Something logical, since his blood pressure at the time of his death was 300/190, something that literally caused an artery to burst. But the “positive” part is that the loss shook the foundations of cardiology.
An implicit rule. Normative stress that 100 plus age years existed was deeply entrenched, although evidence against it already existed. In 1931, Dr. John Hay, during a conference of the British Medical Association, already criticized this “popular belief” and proposed cut-off points that seem much more reasonable to us today: 126/81 at age 40, 130/83 at age 50 and 135/85 at age 60.
However, these words fell on deaf ears, as years after President Roosevelt’s death, many doctors continued to enforce this rule with their patients.
A turning point. Despite this denialist environment, the Framingham Study emerged in the United States, a longitudinal investigation that would change medicine forever. Something that began in 1957, when Thomas Dober first published data indicating that a person’s blood pressure of 160/95 up to four times the risk of coronary heart disease.
But Framingham had other ideas to break down, since until then, doctors who were concerned about high blood pressure ignored systolic pressure (“high”) and focused only on diastolic pressure (“low”). It wasn’t until 1971, after following the cohort for 14 years, that Cannell and his team provided significant evidence that systolic pressure was equally or more important in predicting coronary heart disease risk.
who raised the alarm. Interestingly, before cardiologists changed their clinical care guidelines, life insurance companies realized that their clients died from high blood pressure based on cold death statistics. We cardiologists had to wait until 1977, when the first major clinical protocols to standardize the monitoring and treatment of patients with hypertension were published.
Since that moment, the guidelines have continued to be updated with new consensus reaching increasingly restrictive blood pressure targets. But what has completely disappeared is the ‘age 100+’ rule, although many patients have had great results in recent years.
Through this Science Blog
Picture | Pavel Danilyuk
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