In all but two, blood pressure was reduced substantially, symptoms of congestive heart failure were relieved, heart enlargement and ECG abnormalities disappeared. Through 1951 hexamethonium bromide became freely used in clinical practice in Australia and throughout the world, the reduction in blood pressure and improvement in symptoms were such as to convince the most reluctant skeptics. The introduction of hexamethonium was a wake-up call to the pharmaceutical industries, and a series of more effective sympathetic blocking drugs with fewer side effects were introduced. And antihypertensive drugs acting through other systems came along, powerful diuretics, drugs that blocked the renin-angiotensin system, drugs acting to slow down the heart and relax blood vessels, are now available allowing flexibility to avoid side effects and optimise blood pressure control. But there has been another step in the battle.
Hypertension can remain symptomless for long periods before arterial or organ damage appears.
Yet even with this ad hoc approach limited to such a small proportion of the hypertensive population, subsequent national mortality data showed marked reduction in mortality from stroke, which is a measure of the impact of hypertension in the community. But in 1970 a paper appeared in the Journal of the American Medical Association reporting the results of a small therapeutic trial in 380 subjects with diastolic pressures of 90 to 114 mms of mercury, so-called mild hypertension, in which drugs reduced hypertensive complications significantly. But the study had limitations. It said nothing about women patients. Patients were included only if they remained hypertensive after two weeks in hospital and a four-month period of observation subsequently.