Medicine Cabinet - Hypertensive therapy: attacking the renin-angiotensin system

Franklin Delano Roosevelt: a case study Much information is available regar ding the medical care of Franklin Delano Roosevelt (FDR).(1,2) Figure 1 sho ws FDR's blood pressures during his presidency. In 1935, FDR's pressure was at the upper end of the normal range but rose significantly over 9 years. By March 1945, FDR became ill, and Howard Bruenn, a cardiologist, was asked to examine the president. Bruenn heard rates during physical examination. A chest x-ray film showed pulmonary edema and an enlarged cardiac silhouett e, Electrocardiography (ECG) gave evidence of left ventricular (LV) hypertr ophy, and urinalysis showed proteinuria. FDR was manifesting several cardio vascular consequences of untreated hypertension; LV hypertrophy, congestive heart failure (CHF), and renal insufficiency. Bruenn initiated digitalis therapy, a low-salt diet, a reduction in FDR's s ubstantial alcohol and cigarette use, and bed rest. Within a week, FDR no l onger evidenced CHF. In August 1944, he had chest pain while giving a campa ign speech on a naval ship. In the captain's quarters, he complained of sev ere, crushing pain for 15 minutes. ECG and white blood cell count showed th at he was not having a myocardial infarction (MI) but angina, another possi ble hypertensive complication. In radio addresses at the time of the Yalta Conference, FDR was audibly wheezing and unable to complete sentences. His blood pressure at the time approached 250/150 mm Hg. Historians believe Sta lin took advantage of a debilitated president, actions that determined the fate of eastern Europe. I n April 1945, while seated for a portrait in his Georgia vacation home, FDR fell unconscious. Bruenn estimated FDR's blood pressure to be 350/195 mm H g. The president died within the hour of another possible hypertensive comp lication, intracerebral hemorrhage.