Interaction between Functional and Structural Elements in Primary Hypertension

Abstract

Hardly more than a century after William Harvey’s monumental discovery and soon after Rev. Stephen Hales performed the first arterial pressure measurement known to history in his mare, a young professor of medicine in Berlin, Samuel Schaarschmidt, who died prematurely in 1747, had identified and even treated a clinical condition defined as ‘spastic constriction of the arteries’. His posthumously published writings reveal that he had a surprisingly good grasp of what we now call ‘essential’ or ‘primary’ hypertension [1]. His treatment was no less astonishing, as it anticipated modern therapeutic principles by some 200 years. Thus, he prescribed elimination of mentally stressful influences, nitrites and venesection, which at least here was a rational use as it reduced venous return. In other words, his scheme of treatment served to depress sympathetic activity, dilate arterioles and veins and reduce cardiac output, which is precisely what modern hypotensive drugs aim at.