History of high blood pressure

High blood pressure remains the world’s leading cause of death, killing 10.4 million people a year. An estimated 1.39 billion people worldwide had high blood pressure in 2010. Despite some measures, the prevalence of hypertension and its adverse effects on cardiovascular morbidity and mortality are increasing globally. The Cambridge World History of Human Disease argues that for centuries The only way to estimate blood pressure was by examining The pulse, and explanations of its strength and rhythm have been shown to help predict Disease and death. The concept of blood pressure was first written down by our ancestors. Because more than 2,000 years ago in the book “Huangdi Neijing, ” there is such a description of the human pulse: “Sheng and Jian Yue bilges. ” These short words are considered by some scholars to be the world’s first record of elevated arterial pressure. “The frequency and stress of the pulse increase as people move, get excited, and even arrive, ” Roman medicine says, possibly the earliest written account of the White coat hypertension. Hippocrates, a Greek physician, believes that stroke causes paralysis of the limbs, both of which are caused by an oversupply of blood to the brain. He also recommended bloodletting for stroke patients, a treatment that lasted until the 18th century. During the Three Kingdoms Period, Sima Yi was very excited and happy after taking back the military power from Cao Shuang, but he was extremely happy and sad, unfortunately fell off the horse, then he “could not speak” , only “hand signal. Sima Zhao, who suddenly fell ill at a wine party, also “unable to speak” , died with his fingers on Emperor Wu of Jin. It is now believed that both Sima Yi and Sima Zhao may have died of strokes caused by high blood pressure. British scientist William Harvey (1578 ~ 1657) , in the 1628 published the Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, he discovered the function of blood circulation and the heart, but also describes when the human body arteries were cut, the blood in the blood pressure driven gushing out, this force is also felt when the pulse is touched. As Harvie himself has said, the introduction of the blood circulation theory will give a great impetus to many related disciplines, such as medicine, physiology, pathology, and so on. How much is unknown or difficult can be revealed, but to complete it, my life is not enough... Harvie did not propose any means of measuring blood pressure, and the first measurement of blood pressure in animals was more than a hundred years after the circulation theory emerged. How was the sphygmomanometer invented? In 1733, a British academic and fellow of the Royal Society, Stephen Hares (1677-1761) performed a blood pressure test on a nearly 14-year-old mare, about 7.6 cm (3 inches) from the abdomen, the left calf artery (ligated in the upper part) was cut. He inserted a 9-foot (274-centimeter)-wide glass tube with a small metal tube attached at the end to keep it perpendicular to the ground, untying the artery and immediately pumping blood into the tube, up to 8.3 feet. This means that the horse’s blood pressure can be maintained at 270 cm column height. In the experiment, the chaplain also observed that the height of the blood increased or decreased slightly with the Horse’s heartbeat, which later became known as systolic and diastolic blood pressure. The artist of the time recorded the first blood pressure readings for horses by the Reverend 1733 Hayes. 1819, French physician and physicist Jean Louis Marie Poiseuille (1797-1869) for easy viewing of the height of blood in a glass tube. A glass tube with mercury inside is used to measure blood pressure. Since the density of Mercury is 13.6 times that of water, this method greatly reduces the length of the glass tube used. This is a small step up from Hares. Obviously, Hares and purcell’s invasive blood pressure measurements are too scary to be used in humans. The real sphygmomanometer was born in 1896. Italian doctor Roxie (Scipione Riva Rocci, 1863-1937) pioneered the use of cuff-to-sphygmomanometer connections to measure blood pressure. Roxie chose the brachial artery as the measuring site, wrapping an approximately 5 cm wide rubber band around the upper arm in a nonstretchable material, air Is pumped into the cuff by a rubber ball attached to the rubber band until the radial pulse can not be reached. The air is then released until the radial pulse reappears, at which point the mercury drops to a reading of systolic pressure. Roxie’s design was a major breakthrough, but it only measured systolic blood pressure in the arteries, and the value was only a speculative divisor, not an accurate one. In 1905 Nikolai Kortkoff (1874-1920) , a Russian army physician, used a stethoscope to measure blood pressure. He found that by tying the upper arm with an armband and applying pressure, and then decompressing, the flow of blood could be heard again through the stethoscope in the armband as the external pressure decreased. His improvements took blood pressure measurements to a whole new level and are still the basic method of blood pressure measurement today. Because Nikolai Krot did not make significant changes to the basic structure of the sphygmomanometer, it is widely believed that roxy invented the cuff sphygmomanometer. In honor of Roxie, the Italian Society of hypertension will award the Roxy Prize to those who have distinguished themselves in the field of hypertension. In 1916, the American physiologist Joseph Erlanger Nobel (winner of the 1944 Nobel Prize in Physiology or medicine) published an important paper. He points out that when blood sounds suddenly become muffled during a blood pressure test, the sphygmomanometer shows the heart’s diastolic pressure, commonly known as “low pressure. ”. The long process of human understanding of hypertension In the course of understanding hypertension, people are not only full of exploration and pursuit, courage and wisdom, but also interweaved with lies and desires, interests and greed. In 1914, J. W. Fisher, a consultant to northwestern Mutual Life Insurance, reported years of research linking blood pressure levels to premature death, finding that the higher the systolic blood pressure, the greater the risk of death. People with systolic blood pressure above 160 MMHG are 2.5 times more likely to die prematurely than those with systolic blood pressure above 140 MMHG. Insurance companies therefore recommend that applications for insurance with a persistently high blood pressure level of 15 MMHG above that of a person of the same age should be further reviewed. Fisher may have been the first to introduce metrology to the study of high blood pressure, and the original purpose of his research seemed to be to make his company lose less money. The scientific community has long been interested in what accounts for the new findings and the high prevalence of the disease. The Cambridge World History of human disease presents experiments in the 1970s and forty on the effects of arterial pressure on sympathetic nervous system, endocrine system, and the renal system, has been able to identify several types of Secondary hypertension. In most cases, however, the cause of essential hypertension remains a mystery. To this day, hypertension is classified as either primary or Secondary hypertension in the guidelines for the prevention and treatment of hypertension. The essential hypertension still accounts for about 90 percent of hypertension. Unfortunately, although the existence of hypertension has been known for a long time, the specific harm of hypertension is still unclear. In the mid-1940s, there was a widespread view, including in the medical community, that “after arteriosclerosis, higher blood pressure is needed to get blood through narrow blood vessels, so hypertension is a compensatory mechanism that should not be interfered with. ” There are no blood pressure drugs in the world, and people with severe or even aggressive high blood pressure who eat only grains, fruits and vitamin pills and avoid eating a diet that includes salt and meat. Either a dangerous operation is performed to sever the patient’s chest, abdomen, or pelvic sympathetic nervous system. The majority of patients with hypertension could not get the necessary treatment, and finally became the victims of hypertension complications. The real turning point in the study of hypertension came in 1945. Just two months after the end of Yalta Conference, one morning, Roosevelt felt a sharp pain in his occipital region and fell to the ground, unconscious. Fifteen minutes later, doctors rushed in to measure his blood pressure, which was as high as 300190mmhg. Soon after, Roosevelt was pronounced dead at age 63! Over the past decade, Roosevelt’s blood pressure has soared: 13678mmhg in 1935,16298MMHG two years later, 188105mmhg in 1944, and 226118mmhg in March 1944, shortly before the Normandy landings, according to a cardiologist, roosevelt was hospitalized with heart failure. The progression from high blood pressure to “hypertensive heart disease” and eventually to “heart failure” was one of the chronic complications of high blood pressure, but doctors at the time were unaware of the severity. When he ran for president in 1944, his ECG showed an enlarged heart and urine protein + + , indicating that high blood pressure had already caused damage to his heart and kidneys. Two years after Roosevelt’s death, in 1946, experts still hold the belief that the increase in systemic blood pressure is a natural reaction to ensure a more normal circulation of the heart, brain and kidneys. Stalin also died of high blood pressure on March 4,1953, “On the night of March 1, Comrade Stalin suffered a cerebral hemorrhage in his residence in Moscow, which encroached on vital brain regions, ” the Pravda newspaper said in a “government announcement. ”. Comrade Stalin is unconscious. Paralysis of right arm and right leg. Lost the ability to speak. Severe dissonance in cardiac activity and inhalation. ” March 5,1953,9:50 a.m, stalin is gone. “The conspiracy theory about the cause of Stalin’s death is not true, he died of physical causes in a villa near Moscow, ” according to an autopsy report on Stalin found by German historian Macias Ur, according to the report, stalin suffers from severe hypertension, arteriosclerosis of the brain and heart, and a fatty liver that is close to becoming cirrhosis of the liver. He suffered a stroke on the left side of his brain, accompanied by a stomach bleed, which eventually led to his death by suffocation. Cigar-smoking Churchill had his first mild stroke (cerebral infarction) back in 1949, and arteriosclerosis became his chief disease. Churchill suffered another stroke (cerebral infarction) in June 1953 and resigned as prime minister for health reasons in 1955. In the 16 years between the age of 75 and his death, he had five strokes. The last stroke, in early 1965, Churchill passed away half a month later in a coma. Of course, Churchill’s strong will, love of sports, wide range of interests also made him 91 years old. In 1948, after Roosevelt’s death, then President Truman signed the National Heart Act, established the National Heart Institute, and allocated vast sums of money from the cerebrovascular disease for heart research, and eventually, over the next decade, define hypertension as a disease. In the 1950s and 1960s, the Framingham heart study was carried out to study the distribution of blood pressure and the relationship between blood pressure and cardiovascular disease, hypertension has been identified as a major risk factor for cardiovascular disease. The Framingham Heart Study, published in Annals of Internal Medicine in 1961, identified hypertension, high cholesterol, and Left ventricular hypertrophy as risk factors for coronary heart disease, after more than 10 years of follow up in 5,209 adult residents. Since then, the whole academic world has awakened. Follow-up studies have shown that smoking, drinking, long-term poor diet, long-term excessive salt, obesity, stress, inactivity and other risk factors for hypertension, hypertension is an important cause of stroke. Hypertension is directly responsible for 62 percent of stroke deaths and 49 percent of myocardial infarction in China, according to a report on the epidemiology and prevention and control of hypertension at the International Forum for innovative development of Public Health 2017. Hypertension increased the risk of coronary heart disease by 20% , ischemic stroke by 39% and hemorrhagic stroke by 54% . The concept of treatment is constantly updated The weapon of High Blood Pressure: drugs to lower blood pressure. From the introduction of diuretics in the 1950s, to Beta blockers in 1964, to the advent of Calcium channel blocker in the late 1960s and mid 1970s, ACE inhibitor was developed in the late 1970s, in the 1990s, there were Angiotensinogen inhibitors. In recent 10 years, single-tablet compound preparation has been paid more and more attention and widely used in clinic because of its ability to improve the compliance and efficacy of antihypertensive therapy. Since 2017, the United States, the European Society of hypertension, the United Kingdom, Canada, China and Japan have published new hypertension practice or prevention guidelines. New developments from these guidelines include a redefinition of hypertension, recommendations for wider use of out-of-office blood pressure measurements, recommendations for the initiation of single-tablet compound preparations, and the setting of lower blood pressure targets. In a sense, hypertension is a modern lifestyle disease, and some new risk factors related to hypertension have attracted medical attention, such as early menopause, environmental pollution, psychosocial factors and socio-economic factors. With the development of research, scholars further realize that hypertension is a syndrome, in addition to lowering blood pressure, interventions are needed to address the risk factors for hypertension, target organ damage, and Associated Diseases, especially arteriosclerosis and diabetes. China issued the first guidelines for the prevention and treatment of hypertension in 1999, which were updated in 2005,2011 and 2018, respectively, under the leadership of the China Hypertension Federation. The regularly updated hypertension guidelines have effectively promoted the improvement of hypertension management. However, China has nearly 300 million patients with hypertension, awareness rate, treatment rate only about 50% , control rate of about 17% , hypertension prevention and treatment shoulder heavy responsibilities, the need for joint efforts of the whole society!

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