A new chemical weapon helps thefami
F COURSE high blood preSSUrc C:lll
be harmless; many people live a
normal life span unaware they
have this condition. And yet a fifth
of all death is directly or Indirectly
due to the results of hypertension.
Against this death there is now defi-
nite chemical hope. An ancient,
mysterious drug from India is help-
ing make successful treatment of
severe hypertension possible for gen-
eral practitioners.
If so many can live years not
knowing they're hypertensive, how
can doctors be sure a given case is
dangerous? They can't, but they
have clues. It's more likely to be
serious when it runs in families or
starts early in grownup life.
Serious hypertension starts insid-
iously; only a minority of its victims
have symptoms (notably fatigue)
that send them to their doctors.
Most high blood pressure is stum-
bled upon at insurance, blood-
donor or routine medical examina-
tions. Hypertension in itself isn't a
discasc. :1n ominous figure - let's
say. 220/120 -simply measures the
pressure in the arteries: the first of
the figures, sj~sfsro~ic pressure, when
the heart's pumping; the second,
diastolic prcssurc, when the heart's
relaxing. Diastolic is as low as the
pressure goes; and. if that's high for
one's age, then there may be dis-
aster. Rut why?
The heart has to pump harder
against a chronic rising blood pres-
sure until at last its muscle may fail.
And when the pressure stays high
for years, it aggravates thickening
and deterioration of arteries. If the
heart arteries plug up, there is a
coronary accident; if the brain
arteries plug or burst, there is a
stroke; and damage to kidney ar-
teries may result in fatal uremia.
This sinister trinity of hyperten-
sive disease of blood vessels of the
heart, brain or kidneys is the king
killer - responsible for the death of
320,000 Americans yearly.
What is it that makes blood pres-
                    3'

32               THE READER'S DIGEST           August
sure go up dangerously? It used to
be thought it began with a harden-
ing and plugging of arteries; it was
believed especially prevalent in over-
weight people. But now it is known
that the great majority of cases start
from deranged nerve activity caus-
ing chronic spasm of the blood
vessels. Overactive impulses go from
deep in the brain out over the
sympathetic nervous system, which,
independently of our will, controls
organs, glands and blood vessels.
The overactive sympathetic nerve
impulses narrow down the little
valves at the ends of the arteries; so
the heart must pump harder to cir-
culate the blood, thus shooting up
the pressure. .
If the sympathetic nervous system
is to blame, why not cut its nerves,
blocking overactive impulses? That
was the bold question asked by the
late great Dr. Max Minor Peet of
the University of Michigan. He
risked the operation on a patient
terribly hypertensive and given up
to die. The man's pressure dropped
to normal. In good health again, he
worked many years - outliving the
doctor who had saved his life.
Dr. Peet's now famous sympa-
thectomy operation - perfected by
Dr. Reginald Smithwick of Boston
and Dr. Keith Grimson of Durham,
N. C. -has saved thousands of
hypertensives who were doomed to
early death. Yet sympathectomy,
though often lifesaving, could not
be the answer. For millions of not
yet desperately ill hypertensives
the operation seemed too risky.
Many wouldn't face it; they pre-
ferred to take their chances with
high blood pressure.
But now that we are in the age of
chemistry, scientists asked, why the
knife? Surely there must be some
chemical that would block the over-
active sympathetic nervous system?
And British searchers, W. D. Paton
and E. G. Zaimis, came up with a
synthetic agent, hexamethonium. It
sensationally knocked terrific blood
pressures down to normal. And from
Ciba laboratories in Switzerland
came hydralazine, commonly known
as Apresoline. This, too, was prom-
ising.
In 1950 Dr. Edward D. Freis, in
Washington, D. C., and Dr. Henry
A. Schroeder, in St. Louis, tried
combining hexamethonium and hy-
dralazine in a double-barreled as-
sault on hypertension. They were
bold. At first they picked only those
hypertensions classed as malignant:
hemorrhages into the retinas of the
patients' eyes dimmed their vision;
they had excruciating headaches and
dizziness to the point of coma; they
were in constant peril of strokes and
of failure of their overburdened
hearts; they were in danger of fatal
uremia.
Why did Freis and Schroeder test
this new treatment first on cases of
malignant hypertension - cases
doomed to death perhaps within
a year? Because the treatment also
was drastic. Hexamethonium was
so powerful that it drove high
blood pressure down until patients
went dizzy,  often passing out,

`9S4      RAUWOLFIA AGAINST HIGH BLOOD PRESSURE        33
falling on their faces. Hydralazine
caused severe headaches and fast
pounding of hearts already likely to
be damaged.
With death the alternative, they
decided to risk the hexamethonium-
hydrakzine treatment. Out of IOO
malignant hypertensives thus treated
by Dr. Schroeder 63 have survived
from one to two years, 57 of them
back working. Blood pressure? Back
practically to normal. No further
damage to their hearts or brains or
even their kidneys. Dr. Freis's re-
sults were similar.
It was historic. For the first time,'
malignant hypertension was stopped,
chemically. But then came word of
how these resurrected lived under a
sword. Eleven patients stopped the
treatment; within a few weeks all
were dead.
If only they'd stuck with it! Hut
sometimes it was too tough to take.
Hexamethonium-hydralazine was
practical for patients in hospitals
and under close supervision of ex-
perts; for many it was too high a
price to pay for living; and it was
hardly the medicine for busy family
doctors to use on hypertcnsives gcn-
erally.
Now arose Rauwolfia, the pow-
dered root of a humble shrub from
India. It had long been medically
advertised in ten Oriental languages
as a remedy for mild and severe
insanities, hysteria and epileptic fits;
for hundreds of years it had been
popularly supposed to be fine for
fevers, difTerc.nt diarrheas and snake
bites. It is reliably reported that
Mahatma Gandhi, by chewing on
this Rauwolfia root, increased the
calm that helped him defy the might
of the British Empire.
In 1950 Dr. Robert Wilkins of
Boston read an article by Hindu Dr.
Rustom Jal Vakil, who said Rau-
wolfia was pretty good for hyper-
tension, too. Crazy though the
Oriental claims for it seemed to be,
Wilkins decided just to try it on
hypcrtensives. He gave it in single
trial doses. Nothing happened. Wil-
kins verv nearly threw Rauwolfia
out the window. But then a seriously
hypertensive woman was given the
Indian medicine six days in succcs-
sion and on the sixth day her prcs-
SUIT was wav down.
What Dr.' Wilkins now found was
strange. Contrary to the other chem-
icals that had been tried, Rauwoltia
was gentle, took days to show any
effect on blood pressure at all. It
was far from a wonder drug; it low-
ered blood pressure only modestly;
it brought only 13 of Wilkins's first
39 cases down to normal.
It developed that Rauwolfia made
up for its modest lowering of pres-
sure by an amazing effect on symp-
toms: it was a tranquilizer; it
soothed headaches and dizziness;
picked butterflies out of stomachs
of anxious neurotics; calmed high-
powered hypertensives who drove
not only themselves but all around
them -and their own blood pres-
sure up to boot.
Rauwolfia had another weird qual-
ity. It tamed the bad effects of the
o;her drugs that Wilkins and his

34                THE READER'S DIGEST           Atlgw
co-workers - Drs. Walter Judson,
William Hallander and Meyer Hal-
perin - had to use to treat severe
hypertension. It slowed down the
fast-pounding hearts caused by hy-
dralazine. It made the use of another
drug,  veratrum, more practical.
Though lowering blood pressure,
veratrum had also made victims
vomit. Rauwolfia made it possible to
cut down the veratrum dose, thereby
preventing nausea.
Rauwolfia's own side-effects were
trivial. Stuffy nose, increased dreams,
overactive elimination. These effects
are generally controllable by cutting
Rauwolfia down to smaller, but still
effective, doses.
This eerie medicine transformed
long-suffering hypertensives. Many
told Wilkins:  "I've never felt so
well," or "This is how I dreamed of
feeling," or "Nothing bothers me."
Yet Rauwolfia, even when com-
bined with hydralazine or veratrum
or both, failed to help every severe
hypertensive. Could the gentle In-
dian medicine tame wild, powerful
hexamethonium and so bring prac-
tical help to these hopeless patients?
Having got a new Rauwolfia ex-
tract (Rauwiloid) from Riker Lab-
oratories, Dr. John H. Moyer, of
Baylor University College of Medi-
cine, Houston, Texas, tried it on a
47-year-old woman who was having
a grim time trying to stay alive on
hexamethonium alone. A year be-
fore, that big dangerous chemical
cannon had  rescued her when
she was in a coma, about to die,
blood pressure: 300/200! Her pres-
sure plummeted to 140/90, normal.
But then it went way below normal;
the hexamethonium that had saved
her life sent her into another ordeal.
Often her pressure was so low her
blood couldn't get to her head when
she stood up, causing total black-
outs. For a year she lived under
this threat in order to stay alive at
all.
Now Moyer added Rauwolfia. Her
pressure steadied. Soon she needed
only half her former dose of hexa-
methonium to keep it near normal.
Then, no hexamethonium at all.
Just Rauwolfia, a few tablets daily.
I've never seen a woman more se-
rene, healthy, lovely - three years
after she should have died.
Moyer and his co-workers - Drs.
R. V. Ford, W. R. Livesay and S. I.
Miller - have brought 27 surely
doomed people out of hypertensive
crises by combined Rauwolfia-hexa-
methonium. They've had failures,
too, going out of control and dying.
But they've seen something highly
significant while saving those 27
lives:
When truly severe high blood
pressure is safely lowered by this
double-barreled attack, then labora-
tory tests give evidence of arrest and
often an actual reversal of deadly
deterioration of the arteries of the
heart, eyes and brain.
At the Jefferson Davis hyperten-
sion clinic in Houston Dr. Moyer
and his young associates - Drs. Ed-
ward Dennis, Warren Hughes, Rob-
ert McCann and Liston Beazley -
are searching for practical ways to

3954      RAUWOLFIA AGAINST HIGH BLOOD PRESSURE       35
help general practitioners fight se-
vere hypertension, chemically. Their
patients are poor and are poor risks.
Some lucky people may beat their
dangerous hypertension down b\; a
nice long rest in hospital or by going
on an ocean voyage. But patients at
the JD clinic couldn't afford either.
The only hope was chemical. The
doctors started with Rauwolfia.
Moyer's young doctors were anx-
ious for me to understand that their
battle against severe hypertension
was not miraculous. There were peo-
ple who couldn't take the treat-
ment; who lapsed it: or whose blood
pressure went out of control.
But the patients they did succeed
in helping thought what happcncd
to them was really something. An
old Negro woman drying her tears
on a bedraggled painted scarf said
she was crving because it was won-
derful ho\; this medicine kept her
working. Another explained how
easy it was now to take care of the
three children she served as Mammy.
The doctors? "They're nice, oh,
they're nice!"
At the JD clinic, crowded with
200 hypertensivcs, the faces of many
reveal a new, curious, chemical
serenity. Why not? Dr. Moyer re-
ports that the chemical treatment
significantly lowers high blood pres-
sure in nine out of every ten; that
it brings it down to normal in nearly
half; and seven out of every ten
who've been seriously sick become
so well that they can again earn
their living.
There's a hint of an even greater
place for humble Rauwolfia - the
strong possibility that it may give
general practitioners a chance to do
what only they can do best. They
may, be able to prevent mild hypti-
tenslon~om becoming serious.
For hypertension has this weak-
ness: ,it usually fools around years
before becoming sinister. Dr. George
A. Perera, of New York City, fol-
lowed the fate of IOO hypertensives
whose condition began when they
were young, average age 32. Their
high blood pressure lasted on the
alperagc nearly 20 years before it was
terminated - by death.
Rauwolfia's deep promise is the
possibility that it may control high
blood pressure serious from the
start. Dr. Wilkins reports a number
of such cases: one young man, for
example, whose blood pressure -
180/120-kept him out of the
Air Force. His heart showed begin-
ning damage. But now, for three
years, one little daily dose of Rau-
wolfia has kept him husky, blood
pressure a low normal; and the bad
heart signs have gone.
Dr. Moyer reports a group of very
early mild hypertensives kept on
Rauwolfia for more than a year,
with 63 percent responding. Rarely
and b~<efly among these the blood
pressure has risen above the gentle
medicine's complete control. Even in
early but moderately severe hyper-
tenslves, responding initially, Rau-
wolfia has kept blood pressure nor-
mal in 40 out of 50; and in the rest
it's quickly and easily brought back
within bounds by adding safe mod-
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36               THE READER'S DIGEST
erate doses of hydralazine, veratrum
or hexamethonium.
Less than five years ago there was
great argument whether physicians,
discovering a high blood pressure,
should tell patients about it. Telling
them might scare the pressure higher.
Such mystification is superfluous
now that there are reliable ways to
keep early hypertension down.
Nationwide, hundreds of thou-
sands of hypertensives are being
treated with Rauwolfia. In active
medical centers all over the country
it's by far the most commonly used
drug for the treatment of hyperten-
sion - because of its safety and its
calming action, both on patients and
on more powerful drugs. Nearly
every physician treating hyperten-
sion has already used it.
Rauwolfia is now available in pure
crystals, Serpasil, produced' by Dr.
Emil Schittler of Ciba laboratories.
The crystals permit smaller doses,
but the crude root (Raudixin) may
hide undiscovered Rauwolfia virtues.
The cost? Only about 20 cents a
day to keep hypertension down.
And the tremendous demand, boost-
ing production, will surely bring the
price down further. Meanwhile, it's
wise to treat hypertension early,
for the cost of treating it later, when
it's severe, runs to $1.50 daily; and,
in hospital, a lot more than that.
A new chemical is now ready to
aid.Rauwolfia in severe cases. Pyrol-
lidinium is more potent than hexa-
methonium and longer-acting and
less violent, according to Drs. Freis
and Moyer.
"Less than five years ago when we
were asked to lower serious hyper-
tension with drugs, we had nothing
to offer," says Dr. Wilkins. "Now
no case can be called impossible to
treat until so proved."