RESUMO
BACKGROUND: Advances in drug therapy for primary (or essential) arterial hypertension have contributed to a significant decrease in the frequency and severity of strokes, coronary artery disease and heart failure, and chronic renal insufficiency. STUDY QUESTION: What are the milestones of the changes in the expert approach to the pharmacological management of arterial hypertension in the past century? STUDY DESIGN: To determine the changes in the experts' approach to the management of arterial hypertension, as presented in a widely used textbook in the United States. DATA SOURCES: The chapters presenting the management of arterial hypertension in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. RESULTS: The pharmacological management of arterial hypertension has had 3 overlapping eras in the timeframe subject to our investigation. In the empiric era (1927-1947), experts were recommending nonspecific interventions for sedation. The premodern era (1955-1963) relied on ganglion blockers, sympathetic blockers, and direct vasodilators. The modern era (1967-2020), which includes drugs used in current clinical practice, saw the introduction of diuretics (1967), beta-blockers (1971), alpha-blockers (1982), calcium channel blockers (1985), angiotensin-converting enzyme inhibitors (1985), angiotensin receptor blockers (2000), and direct renin inhibitors (2008). CONCLUSIONS: The pharmacological management of arterial hypertension has been the focus of intense and successful research and development in the second half of the 20th century.