How the Times Have Changed: Cardiovascular Disease

This Editorial is a personal reflection on an article from the Consultant archives and was written by a Consultant Editorial Board member.

Author:
Michael J. Bloch, MD

Citation:
Bloch MJ. How the times have changed: cardiovascular disease [published online August 24, 2018]. Cardiology Consultant.

Galesnick B. Which hypertensive patients need treatment? Consultant. July 1961;18-21. https://www.consultant360.com/exclusive/cardiology/which-hypertensive-patients-need-treatment.

I was born October 18, 1966, in a community hospital in Omaha, Nebraska. On that same weekend, at that same hospital, my paternal grandfather died of complications of longstanding established cardiovascular disease in his early 50s. In reading this article from 1961, I can only wonder how my family would have been personally affected had the medical community of that era had more clearly recognized the importance of identifying and aggressively treating all patients with hypertension, not just those with extremes of presentation.

While we may still argue about the margins of hypertension management—how to measure blood pressure, and exactly who to treat and how aggressively, I think it is important to recognize the broad areas of consensus that have taken hold among those of us who regularly treat hypertension. 

Over just a generation or two, it has become firmly established that even modest increases in blood pressure, both systolic and diastolic, significantly increases cardiovascular risk in both men and women and at all ages. Reducing blood pressure with our widely varied, well-tolerated, contemporary antihypertensive agents, alone or in combination, has been definitively demonstrated to decrease cardiovascular disease in nearly every patient population studied.

Certainly, the management of chronic asymptomatic diseases like hypertension can be extremely frustrating for both patients and providers in our modern healthcare system. However, as I remind my students and trainees, it is impossible to see a heart attack or stroke that did not occur because of our treatment of hypertension. We need to remind ourselves that if we are identifying and treating hypertension in our patients, we are preventing large numbers of cardiovascular events and providing great solace to our patients and their families. We should take great pride in how far we have come.

Michael J. Bloch, MD, FACP, FASH, FNLA, FSVM, is an Associate Professor, Department of Medicine, University of Nevada School of Medicine, and Medical Director, Vascular Care, Renown Institute for Heart and Vascular Health.