Desperate diseases, desperate measures: Tackling malignant hypertension inthe 1950s

Background The conquest of malignant hypertension is one of the most import ant medical achievements of the second half of the 20th century. As we ente r the new millennium, it is critical to examine the efforts that have led t o our ability to treat this once incurable disease. Methods Review was performed of the literature from 1900 to the 1950s regar ding the etiology, clinical evaluation, and treatment of hypertension, focu sing on malignant hypertension. Results Fifty years ago, in a time of sparse treatment options, the occurre nce of malignant hypertension was a dreaded event that taxed the aptitude o f the clinician. Confronted with an "extreme disease," physicians chose to use "extreme methods of cure" in conformity with the teaching of Hippocrate s, In the 1950s malignant hypertension was treated with such drastic measur es as rice diet, sympathectomy, and intravenous pyrogens. Conclusions In the practice of medicine today, while work is being done to reassert biomolecular mechanisms, we still face patients who have reached t he end stages of failure and manifest devastating morbidity. These patients are subjected to "extreme therapies" reminiscent of those that surrounded malignant hypertension in the past. In an era when adequate treatment of hy pertension has become a reality for so many patients, it is appropriate to give credit to those who paved the way to such great progress.