A Doctor Updates the Fight Against 'the Silent Killer—and the News Is Mostly Good

“The damages caused by high blood pressure maybe the nation’s No. 1 killer,” says Dr. John Laragh, founder and chief of the hypertension research and treatment center at New York Hospital-Cornell University Medical Center. High blood pressure alone is listed as the primary cause of only 60,000 deaths a year, but it is the underlying cause of hundreds of thousands of deaths from heart attack, stroke and kidney failure. Recent success in treating the disease stems in large part from the research of the 53-year-old Laragh and his staff. A graduate of Cornell University and its medical school, he was co-winner of the $50,000 Stouffer Prize in 1969 for identifying and defining the body’s chemical system that controls blood pressure and fluid balance. Two years earlier he had established for the first time a link between the Pill and high blood pressure in women. He has written textbooks on hypertension and teaches pathology, cardiology, pharmacology and clinical medicine at his alma mater. Helping him in his work is his second wife, Jean, 41, a Scottish-born biochemist. Laragh has two sons, Peter, 26, and John, 28, by a former marriage. He lives in Manhattan, across the street from his office where he often puts in seven-day weeks. Recently he spoke about his research with Patricia Burstein of PEOPLE.

What is hypertension or high blood pressure?

It’s a common medical disorder in which pressure in the arteries exceeds what is found in healthy people.

What is blood pressure?

The adult human body has some 60,000 miles of blood vessels. As the body’s blood—five quarts or more in the average adult—is pumped by the heart through arteries, capillaries and veins, it exerts force on the walls of these vessels. Like pipes in a plumbing system, the arteries can tolerate high pressure for brief surges. But persistent pressure is dangerous.

How many people suffer from high blood pressure?

Twenty percent of the adults in this country have hypertension. That means about 27 million Americans. For reasons we still don’t understand, it’s almost twice as prevalent in blacks.

Is any special age group susceptible?

It begins to show up over 30. The onset increases between 40 and 50 and then continues to go up with age. High blood pressure is rare, one percent or less, in children.

What are the warning signals?

There are none. That is why hypertension is called “the silent killer.” You can have high blood pressure without feeling or perceiving it.

Then how do victims find out?

They have a heart attack or a stroke. They only feel the consequences of high blood pressure when it damages the arteries enough to cause an attack. Thus the symptoms are really results of the damage.

Are there minor symptoms?

Yes, but they are headaches, shortness of breath and heart palpitations, which can be mistaken for symptoms of other ailments.

How do doctors diagnose high blood pressure?

By checking the blood pressure, one of the simplest medical techniques. It is truly a tragedy that something requiring so little effort is not done more often. In the past a patient could undergo an entire hospitalization and never have his blood pressure taken. The procedure should be as familiar as using the family thermometer.

How often should it be checked?

After the age of 40 everybody should have his or her blood pressure taken at least once a year.

How long have doctors been able to measure blood pressure in patients?

Since 1896. Hypertension itself was first suspected in 1826 by Dr. Richard Bright. It was described as “the pulse was bounding.”

Do we know the cause of high blood pressure?

No, but we do know certain things, such as the higher the blood pressure, the shorter the survival. That is why life insurance companies’ actuarial charts rely heavily on blood pressure statistics.

Do tense people have hypertension?

Not necessarily. Hypertension does not mean someone is a nervous wreck. It has a strict biophysical definition. “Hyper” means too much, and “tension” is pressure. Physicians have never intended it to mean a state of anxiety.

Then the nerves are not a factor in hypertension?

We don’t know. We do know that a special set of sympathetic nerves is always operating to instantly constrict or open up blood vessels. In the meantime we have found that Transcendental Meditation does not lower the blood pressure. And hypnosis may make it go up.

Do exercise and weight control affect hypertension?

Again, there is no proof. But being thin and in good physical condition can’t go against you.

What else helps?

If you can correct high blood pressure with drugs, you can prevent heart attacks and strokes and thereby prolong life.

What advances have been made?

We have discovered a chemical control system in the body called the renin system. In it two hormones work together—one made by the kidneys, renin, and the other by the adrenal glands, aldosterone. Renin controls blood pressure; aldosterone, the volume and flow of blood so that vital organs like the brain, heart and kidneys get enough nutrition.

How does it work?

When renin is secreted into the bloodstream, it constricts the arteries and raises blood pressure just as tightening the nozzle on a hose creates higher pressure. When too much renin is injected into animals, for instance, it produces heart attacks and strokes.

How do you test for renin?

We have a simple Renin Profile Test in which a patient collects his urine over a 24-hour period. He brings in the sample for salt measurement and we also do a blood test to see how much renin is present. The salt-renin index tells us how constricted the arteries are and whether that constriction is normal.

How much does the lab test cost?

From $25 to $100. It is a relatively small investment for someone to find out whether his hypertension is caused by kidney or adrenal disease, which can be cured by surgery. But in most cases these are not the cause. Still, the doctor can tell from the level of renin what type of drug to prescribe for the remaining majority.

What is the role of salt in the diet?

We know now that all high blood pressure is not alike. Patients with too much renin probably need some salt; those with low renin should avoid it.

Are there certain foods to avoid to help prevent hypertension?

None, except those high in salt for the low-renin patient.

What are the drugs prescribed?

In low-renin patients we use diuretics to stimulate excretion of fluids and excess salt, which tend to aggravate high blood pressure. If renin is high, we have drugs called beta-blockers that act on the nerves which control renin secretion. We can thereby control the constriction of the blood vessels.

What are the side effects of current hypertension medicines?

The older drugs, such as reserpine, methyldopa and guanethidine, all had serious effects on the nervous system including drowsiness and impaired thinking, dizziness, impotence and general weakness. The new beta-blockers are far more palatable. Their few side effects include asthma in susceptible people and a slowing of the pulse.

How do you view the new pill (SQ 14225) developed by Squibb’s research institute and recently tested successfully at Boston University Medical Center?

I’m extraordinarily hopeful. The new pill is the oral form of what we were the first to give intravenously to patients, and it follows our research predictions. The pill blocks the enzyme that produces the constricting substance. It does so more effectively than beta-blockers and apparently with even fewer side effects. So far it has proven to be effective in 70 percent of our experiments. However, it will be another two years before it is on the market.

What is the prognosis for hypertension sufferers?

With the new drugs, a patient can live a long and merry life if he takes the medicine. But convincing people to take a pill for life when they don’t have symptoms is a feat. To many, hypertension seems to be a remote threat. But remember, it is the silent killer.