Mortality trends are often cited to justify public health priorities and to legitimate professional activities. For example, the decline of cardiovascular disease mortality in recent decades has been cited frequently as affirmation of the proper conduct and direction of medical and public health research. In this paper, the hypothesis that medical intervention is the major cause of hypertension-related mortality declines is reviewed. Evidence relevant to the “medical hypothesis,” including mortality data and patterns of antihypertensive drug development and treatment, is presented. While it is clear that factors other than medical intervention must have played the major role in hypertension-related mortality trends for most of the period of the decline, much scientific literature increasingly promotes the view that medical intervention is the crucial factor in mortality trends. The role of the medical hypothesis in supporting status quo political and economic interests is discussed, and alternative explanations for mortality trends are considered.
Get full access to this article
View all access options for this article.
References
1.
NavarroV.Work, ideology and science: The case of medicine. Int. J. Health Serv. 10(4): 523, 1980.
2.
McKeownT.The Role of Medicine: Dream, Mirage or Nemesis?Nuffield Provincial Hospitals Trust, London, 1976.
3.
McKinlayJ.McKinlayS.The questionable contribution of medical measures to the decline of mortality in the U.S. in the twentieth century. Milbank Mem. Fund Q. 53(3): 405, 1977.
4.
OmranA.Epidemiologic transition in the U.S. Pop. Bull.32(2), 1977.
5.
RossR.GlomsetJ.The pathogenesis of atherosclerosis (2 parts). New Engl. J. Med.295: 369, 420, 1976.
6.
OstfeldA.A review of stoke epidemiology. Epidemiol. Rev.2: 136, 1980.
7.
NeserW.TyrolerH.A.CasselJ.Social disorganization and stroke mortality in the black population of North Carolina. Am. J. Epidemiol.93: 166, 1971.
8.
JamesS.KleinbaumD.Socioecologic stress and hypertension related mortality in North Carolina. Am. J. Public Health66(4): 354, 1976.
9.
Society of Actuaries. Blood Pressure Study, 1979. Society of Actuaries, 1980.
10.
DustanH.SchnecklothR.CorcoranA.PageI.The effectiveness of long term treatment of malignant hypertension. Circulation18: 644, 1958.
11.
PeeryH.SchroderH.The effect of treatment on mortality rates in severe hypertension: A comparison of medical and surgical regimens. Arch. Int. Med.102: 418, 1958.
12.
StamlerJ.StamlerR.RudlargerW.Hypertension screening of 1 million Americans. JAMA. 235: 2299, 1976.
13.
Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. III. Influence of age, diastolic pressure, and prior cardiovascular disease; further analysis of side effects. Circulation45: 991, 1972.
StamlerJ.StamlerR.Perspectives on the prevention and control of high blood pressure. Urb. Health, May 1982: 26.
16.
FriesE.Should mild hypertension be treated?New Engl. J. Med.307(5): 306, 1982.
17.
HegelandA.Treatment of mild hypertension: A five-year controlled drug trial—the Oslo Study. Am. J. Med.69: 725, 1980.
18.
SmithW.Treatment of mild hypertension: Results of a ten-year intervention trial. Circ. Res. (Supp I) 40(5): 1–98, 1977.
19.
BorhaniN.HechterH.H.Recent changes in CVR disease mortality in California. Pub. Health Rep. 79(2): 202, 1964.
20.
HowardJ.Race differences in hypertension mortality trends: Differential drug exposure as a theory. Milbank Mem. Fund Q. 43(2): 202, 1965.
21.
HowardJ.TiedemanG.The relative effectiveness of antihypertensive drugs in Caucasians and Negroes. Clin. Pharm. Ther.8: 502, 1967.
22.
PaffenbargerR.MillingR.PoeN.KruegerD.Trends in death rates from hypertensive disease in Memphis, Tennessee, 1920–1960. J. Chron. Dis.19: 847, 1966.
23.
KullerL.SeltserR.PaffenbargerR.KruegerD.Trends in cerebrovascular disease mortality based on multiple cause tabulation of death certificates 1930–1960: A comparison of trends in Memphis and Baltimore. Am. J. Epidemiol.88(3): 307, 1968.
24.
GordonP.The epidemiology of cerebral vascular disease in Canada: An analysis of mortality data. Canad. Med. Ass. J.95: 1004, 1966.
25.
StallonesR.Epidemiology of cerebrovascular disease: A review. J. Chron. Dis.18: 859, 1965.
26.
WylieC.Recent trends in mortality from cerebrovascular accidents in the U.S. J. Chron. Dis.14:213, 1961.
27.
SchweitzerM.GearingF.PeraraG.The epidemiology of primary hypertension: Present status. J. Chron. Dis.18: 847, 1965.
28.
MoriyamaI.KruegerD.StamlerJ.Cardiovascular Disease in the United States. Harvard University Press, Cambridge, 1971.
29.
CooperR.StamlerJ.DyerA.GarsideD.The decline in mortality from coronary heart disease, U.S.A. 1968–1975. J. Chron. Dis.31: 709, 1978.
30.
SolteroI.CooperR.Improved hypertension control and decline in cardiovascular mortality. Comp. Ther.6(3): 60, 1980.
31.
LevyR.MoskowitzJ.Cardiovascular research: Decades of progress, a decade of promise. Science217: 121, 1982.
32.
LevyR.Declining mortality in coronary heart disease. Arteriosclerosis1(5): 312, 1981.
33.
DustanH.Research contributions toward prevention of cardiovascular disease: Research related to the underlying mechanisms in hypertension. Circulation60(7): 1566, 1979.
34.
SolteroI.LiuK.CooperR.Trends in mortality from cerebrovascular diseases in the U.S. 1960 to 1975. Stroke9(6): 549, 1978.
35.
CooperR.SteinhauerM.SchatzkinA.MillerW.Improved mortality among U.S. blacks, 1968–1978: The role of the antiracist struggle. Int. J. Health Sen. 11(4): 511, 1981.
36.
BorhaniN.Mortality trend in hypertension, United States, 1950–1976. In HavlikR.FeinleibM. (eds.), Proceedings of the Conference on the Decline of Coronary Heart Disease Mortality. DHEW Pub. No. 79-1610. U.S. Government Printing Office, Washington, D.C., 1978.
37.
SymeS.The Social Environment and Disease: Towards a Proper Epidemiology. The first John Cassel Memorial Lecture, presented at the 16th annual meeting of the Society for Epidemiologic Research, Winnipeg, Canada, June 17, 1983.
38.
Hypertension Detection and Follow-up Program Cooperative Group. The Hypertension Detection and Follow-up Program: A progress report. Circ. Res. (Supp I), 40(5): 1–106, 1977.
39.
HarrisonT.AdamsR.ResnikW. (eds.). Principles of Internal Medicine. McGraw-Hill, New York, 1962.
HjermannI.HolmeI.ByreK.LerenP.Effect of diet and smoking intervention on the incidence of coronary heart disease. Lancet, Dec. 12, 1981, pp. 1303–1310.
42.
HardyR.HawkinsC.The impact of selected indices of antihypertensive treatment on all-cause mortality. Am. J. Epidemiol.117: 566–574, 1983.
43.
GoverM.Mortality Among Southern Negroes Since 1920 with Comparative Data for Southern Whites and Northern Negroes. Public Health Bulletin No. 235. U.S. Treasury Dept., Washington, D.C., 1937.
44.
NichamannM.BoyleE.LesesneT.SauerH.Cardiovascular disease mortality by race, based on a statistical study in Charleston, South Carolina. Geriatrics17(11): 724–737, 1962.
45.
HolmeI.Coronary Risk Factors and Their Possible Causal Role in the Development of Coronary Heart Disease, The Oslo Study. Ulleval Hospital, Oslo, 1982.
46.
GordonT.MooreF.ShortleffD.DawberT.Some methodologic problems in the long-term study of cardiovascular diseases: Observations on the Framingham study. J. Chron. Dis.10: 186, 1959.
47.
CriquiM.Barrett-ConnerE.AustinM.Differences between respondents and non-respondents in a population-based cardiovascular disease study. Am. J. Epidemiol.108: 367, 1978.
48.
WingS.MantonK.The contribution of hypertension to mortality in the U.S.: 1968, 1977. Am. J. Public Health73(2): 140, 1983.
49.
KullerL.Epidemiology of cardiovascular diseases: Current perspectives. Am. J. Epidemiol.104(4): 425, 1976.
50.
ScotchN.GeigerH.The epidemiology of hypertension II. J. Chron. Dis.16: 1183, 1963.
51.
HenryJ.CasselJ.Psychosocial factors in essential hypertension. Am. J. Epidemiol.90: 171, 1969.
52.
JamesS.HarnettS.KalsbeekW.John Henryism and blood pressure differences among black men. J. Beh. Med.6: 259–278, 1983.
53.
SymeS.OakesT.FriedmanG.Social class and racial differences in blood pressure. Am. J. Public Health64(6): 619–620, 1974.
54.
MorgansternH.Uses of ecologic analysis in epidemiologic research. Am. J. Public Health72(12): 1336, 1982.
55.
HoltzmanE.Science, philosophy and society: Some recent books. Int. J. Health Serv. 11(1): 123, 1981.
56.
WaitzkinH.A Marxist view of medical care. Ann. Int. Med.89: 264, 1978.
57.
U.S. Department of Health and Human Services. Hypertension in Adults 25–74 Years of Age, United States, 1971–75. Vital and Health Statistics, Series 11 No. 221, DHHS Pub. No. 81-1671, 1981.
58.
KitagawaE.HauserP.Differential Mortality in the United States: A Study in Socioeconomic Epidemiology. Harvard University Press, Cambridge, 1973.
59.
SclarE.Community economic structure and individual well-being. Int. J. Health Serv. 10(4): 563, 1980.
60.
GilbertD.KahlJ.The American Class Structure: A New Synthesis. Dorsey Press, Homewood, Ill., 1982.
61.
Hypertension Detection and Follow-up Program Cooperative Group. Five year findings of the HDFP I. J.A.M.A.242(23): 2562, 1979.
62.
TyrolerH.A.Race, education, and 5-year mortality in HDFP stratum I referred-care males. In Mild Hypertension: Recent Advances, edited by GrossF.StrasserT., Raven Press, New York, 1983.
