Some Newer Aspects in the Problem of Essential Hypertension

BRIGHT, ioo years ago, showed that there was a relationship between pathologic changes in the kidney and diffuse vascular disease. Forty years later, Johnson, Gull, and Sutton demonstrated in cases similar to those cited by Bright that there might also be injury to the peripheral vessels including the arterioles. Thirty-five years ago Allbutt showed clinically and pathologically that diffuse vascular disease with hypertension, without renal lesions, and without gross periph-eral vascular lesions, could exist. Since that time, of course, many observers have wondered as to the cause of hypertension, and there have been theories that the thyroid gland and the suprarenal gland were involved. In the last few years certain anatomic conditions of the vascular system have been recognized as being associated with hypertension. Much has been learned concerning the diagnostic and prognostic significance of retinal vas-cular changes. Moreover, certain rare conditions of the vascular system have come to be recognized as causative of