Heart failure in patients with high blood pressure.

In the course of four years work in a clinic for the investigation and follow up of high blood pressure, the impression has been gained that although hypertension may increase greatly the work of the heart, the heart does not fail unless some additional embarrassment is imposed. Hypotensive drugs have, by reducing the work load of the heart, increased the relative importance of these additional factors. It has for long been accepted that heart failure is a common complication and a major cause of death in patients with high blood pressure. Thus the mortality from this cause found by Bell and Clawson (1928) was 44 per cent; that recorded by Murphy et al. (1932) 50 per cent; by Fahr (1935) 55 per cent; and by Clawson (1941) 43 per cent. It is the purpose of this paper to assess the cause or causes, over and above overwork of the left ventricle, that bring about failure in this common malady.