Get Dr. Marvin Moser talking about the history of hypertension treatment and you might not believe what you hear.
The Scarsdale doctor known around the world as an authority on cardiovascular disease and hypertension said it was only back in the 1920s through most of the ”™40s when doctors were prescribing what is now considered “radical treatments” to help people reduce their blood pressure.
These ranged from low-salt diets so extreme that patients were limited to a menu of fruit juice and rice administered in a boot-camp atmosphere to injecting typhoid bacilli, a move that would bring a high fever that in turn would dilate blood vessels.
By the late ”™40s, drug treatment was being introduced, and therapies have continued to progress, Moser said.
“There were developments of dozens of drugs, each one a little more effective, each one a little more safer.”
Today, there are countless options for treating hypertension. Untreated, dire complications come into play. An elevated blood pressure, generally considered more than 140/90, puts the body at greater risk of stroke and heart and kidney failure.
The importance of identifying and treating hypertension is not always understood, said Moser, emeritus editor-in-chief of the Journal of Clinical Hypertension who has also served as chairman several committees of the National Institutes of Health. He is a clinical professor of medicine at Yale University School of Medicine and he continues to lecture and write on hypertension.
“A problem with hypertension is it doesn”™t hurt,” he said. “Most, but not all ”¦ most people don”™t have any symptoms.”
But once it is diagnosed, the treatment is often straightforward, he said.
Today, a doctor might see a patient, prescribe pills to lower blood pressure, make sure they are working and then see that patient every six months for monitoring, a long way from less than a century ago.
While treatment is readily available, the main cause of hypertension is often not understood, he added. Most assume it”™s a direct result of high stress.
Stress is a factor but not over the long term. Moser said blood pressure may indeed rise when in an emergency situation, such as a fire or when going through a trauma such as the death of a loved one.
But he added, “There”™s very little evidence that chronic stress is a major cause of high blood pressure.”
It is though, he noted, a “contributing factor.”
“There”™s a lot of calm cool characters who have hypertension,” he said.
Often, the culprit is more diet-related.
“In most people, it”™s probably the inability to handle salt as effectively as they would like,” Moser said. “About 40 percent of the people, we don”™t know the exact number, are salt-sensitive.”
After 30 or 40 years of excessive salt intake, usually from a combination of salt added to meals and that already found in processed foods, the body starts to fail.
When it comes to eating better, Moser said most people know to avoid the usual high-salt suspects such as canned soups, but a perhaps unexpected source is baby food that can start the problems at the youngest age.
“Salt is an acquired taste,” he said. “We”™re not born craving salt.”
Carrying extra weight is another strain on the body and it impacts blood pressure.
“Yes, obesity is a major contributing factor for hypertension,” Moser said.
It all adds up to a continuing need to focus on hypertension education, prevention and treatment, said Moser.
“It”™s one of the great stories of medical care,” he said of hypertension
Even though, he added, it”™s harder to get people to listen.
“It”™s a great field, but it”™s very boring,” he said.
“Students certainly appreciate the prevention of coronary disease,” he said, but noted it is not a field that”™s considered cutting edge. Hypertension is often diagnosed and treated, he said, and the patient continues to live a normal life. “The drama comes when 10 years from now you say ”˜I haven”™t seen a stroke in these people.”™”
It”™s that kind of success that seems to keep Moser dedicated to his chosen field ”“ and spreading the word through publications such as the new ninth edition of his seminal book, “Clinical Management of Hypertension.”
“(Doctors) give a lot of lip service to patient education,” he said regarding hypertension. But, he continued, when you go to many medical offices most of the materials are focused on AIDS, breast cancer and diabetes.
“They have very little on high blood pressure,” he said.
That is why the foundation of which he is president ”“ the Hypertension Education Foundation ”“ is dedicated to patient education, distributing booklets and offering online support at hypertensionfoundation.org.
After all, Moser said, education is paramount when it comes to treating hypertension: “It”™s a controllable disease.”
