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  • Print publication year: 2018
  • Online publication date: January 2018

5 - ACE Inhibitors: Kidney Clamps, Snake Venoms and Peptidomimetics



Physicians have known of the consequences of hypertension and been measuring blood pressure (BP) a lot longer than they have had the tools to do anything about it. The fate of President Franklin D. Roosevelt (FDR) is a case in point. In 1937 at age 55 FDR's BP was 169/98, on December 7, 1941 when the Japanese attacked Pearl Harbor it was 188/105, and on Thanksgiving Day 1944 it was 260/150. Two hours before his death from a cerebral hemorrhage at age 63 on April 12, 1945 it was 300/190. Though FDR's physician, Ross T. McIntire, boldly stated that the President's death “came out of the sky,” he and other physicians had long been aware that all was not right. Eleanor, FDR's wife, knew it too. Indeed, it was at her insistence that the President had previously undergone a thorough examination at the Bethesda Naval Hospital, where Howard Bruenn, a young cardiologist, concluded that FDR was desperately ill with life-threatening hypertension and heart failure. However, Bruenn and McIntire were powerless to do much about it. FDR was initially prescribed digitalis, the only drug available at the time for the treatment of heart failure, and toward the end of his life the sedative phenobarbital, but both proved to be ineffective.


The stark reality of the epidemiology of cardiovascular disease (CVD) was detailed in the statins chapter (Chapter 4). And much the same applies to long-term hypertension because it is a major factor in coronary artery heart disease, stroke, heart failure, peripheral vascular disease, and vascular retinopathy, as well as chronic kidney disease. In its most common form, primary or essential hypertension, which accounts for 90–95 percent of cases, lifestyle and/or genetic factors are thought to be responsible. In its less common form, secondary hypertension, which affects 5–10 percent of cases, chronic kidney disease, renal artery stenosis, and/or endocrinological disorders are usually to blame.

According to the US Centers for Disease Control and Prevention (CDC) some 75 million American adults have hypertension, and another 75 million have its antecedent, prehypertension, meaning that roughly two-thirds of the adult population have one form or the other. In terms of cost to the nation to cover health care services, medications, and days of work lost, this amounts to about $48.6 billion.

Hypertension, sometimes known as the “silent killer,” was responsible for the deaths of more than 410,000 Americans in 2014.