Hypertension – Origins

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When did hypertension enter medical nosography as a disease?

It all started in antiquity with the recognition of the pulse as a sign of life, death, and disease. The Mesopotamian epic of Gilgamesh (c. 2600 BCE) records the lament of its protagonist, Gilgamesh, at the death of his best friend, Enkidu, “I touch his heart but it does not beat at all.” How he touched the heart is not stated. That the pulse was synchronous wherever felt on the body and coincided with the heartbeat is recorded in ancient Egyptian medical texts of about 1500 BCE. Variations in the frequency and force of the pulse in the course of diseases was studied and refined in ancient Chinese medicine, where the diagnosis and site of disease was made by palpation of the pulse. Whereas examination of the pulse ( sphygmós ) was used and recorded in Greek medicine, its physiologic study was hampered by the concept of the circulation promulgated by Galen (130–210) that blood is made in the liver, from whence it flows to and fro in the vasculature, and that “vital spirits” are added to it in its course through the heart, an erroneous view that prevailed for fifteen centuries until the discovery of the circulation in 1628 by William Harvey (1578–1657). Harvey showed that blood circulates and that ventricular systole provides the force that drives it through the arteries and causes their pulsation. It is from these foundations that the force of the blood pressure which had been assessed from the pulse came to be identified as a clinical condition that deserved better scrutiny in the 18th century.

That an arterial pulse that is hard to compress is an omen of poor health has been recognized since antiquity. Its association with shortened life and lesions of the brain, heart, and the kidneys began to be studied in the 19th century, after the report that a hard pulse was associated with ventricular hypertrophy in patients with kidney disease by Richard Bright (1789–1858) in 1836. However, it was only with measurement of the blood pressure by sphygmography (writing of the pulse, from the Greek for pulse, sphygmós and from Latin for writing, graphia ) that quantification rather than mere qualitative description of the arterial pulse began to be studied in the 20th century. The epidemiologic data that accrued thereafter documented the clinical relevance of elevated blood pressure and identified hypertension as a disease rather than a mere sign of disease.