HYPERTENSION AS CAUSE AND CONSEQUENCE OF RENAL-DISEASE IN THE 19TH-CENTURY

The pioneering work of Richard Bright, who introduced the concept of t he renal origin of cardiovascular disease, initiated the continuous un folding of knowledge on renal disease and its close interrelationship with arterial hypertension in the 19th century. Hypertension as a clin ically and pathologically defined entity, however, was not established . The partial elucidation of the problem that the diseased kidney was sometimes the cause and sometimes the consequence of elevated blood pr essure is not only fascinating but also remarkable, given the crude te chniques available to physicians at that time. Subsequent workers came to regard 'Bright's disease' as consisting of several conditions diff ering in clinical manifestation and pathology. In particular, Johnson and Gull and Sutton drew attention to the small blood vessels in renal disease. Only the invention of a clinically applicable method of meas uring blood pressure indirectly allowed Mahomed and Allbutt to show th at hypertension may occur in the absence of renal disease. They paved the way for a clear separation of hypertensive renal disease from othe r forms of 'Bright's disease', culminating in the classification intro duced by Fahr and Volhard.