Hypertension

During Fred Bowerbank's time as Cardiologist, hypertension was generally ignored.  In the 1940s there was a vogue for using a low sodium diet in patients with malignant hypertension.  A breakthrough occurred in 1950 when, from Dunedin, Horace Smirk reported on the successful use of hexamethonium by subcutaneous injection 2 - 3 times/day in 15 patients with severe hypertension.  A major side-effect was postural hypotension.

Physicians at Wellington Hospital began using hexamethonium soon after Smirk's report, the patients being admitted to hospital until control was achieved without symptomatic postural hypotension.  This practice imposed a significant load on available beds.   In 1954 Charles Burns and other physicians proposed that a Hypertension Clinic be established, a concept that Smirk had pioneered.   Approval was given for the clinic, initially referred to as the Hexamethonium Clinic, and for the appointment of a part-time physician in charge, and up to two technicians.

Ponty Hallwright, who had been appointed visiting Assistant Physician in 1953, was appointed as the founding Physician-in-charge, Hypertension Clinic in 1955.   It had been intended that the clinic be sited in ward 1A, but this plan fell through and it was initially established in ward 2.

Sister Doris Gayne was appointed to manage the clinic on a day-to-day basis and would remain in charge until she retired in 1975.

Part of the initial assessment of new referrals to the clinic was the recording of basal blood pressure.   Patients, typically two - four at a time, would be admitted to the clinic for overnight rest and sedation.   The following morning a number of BP readings would be recorded, generally by Sister Gayne, and often while the patient was still asleep.   Once established on treatment, repeated lying and standing BP readings were taken in the clinic, over the course of a full day or half day - known as the 'day test' and 'half-day test' respectively.    Given that the early drugs were posturally active, measuring the drop in BP whilst standing was important.
When the Cardiology Department moved to the old ward 4 site in 1958, the Hypertension Clinic moved there too.

Other drugs available during the early years of the clinic were Rauwolfia (Reserpine), Hydralazine and Chlorothiazide, and use of these often allowed the physician to use lower doses of the posturally active drugs.  In 1960, two new ganglion blocking drugs which could be given orally became available.  Bretylium tosylate, developed in the UK, and Guanethidine (Ismelin) from the US replaced Hexamethonuim.   Guanethidine especially became popular during the 1960s.

Because all these drugs came with significant side-effects and BP control required fairly intense supervision, the Clinic became very busy and extra staff were required.  Additional visiting Physicians were appointed.   Frank Hall (1956 - 1971) and John Todd (1958 - 1978) both worked one session each week.  Extra technical staff were required too, and by the early 1970s, there were 3 - 4 technicians plus Sister Gayne and a staff nurse running the clinic.

When Beta-Blockers became available, they were a major advance in the treatment of severe hypertension as there was no postural effect.   Similarly, the addition of ACE-Inhibitor drugs provided a very effective option for treatment of hypertension.   Ponty Hallwright was one of the investigators involved in proving the value of Captopril.
Leon Jellett ran one clinic/week from 1976 - 1979 and was succeeded by Tim Maling, both having been appointed to the School of Medicine and Hospital as Clinical Pharmacologists.

During the 1980s, a significant number of patients were now being managed by their GPs and referral numbers began to decrease.
The Day Test had been phased out and fewer Half-day Tests were performed.  After Sister Gayne's retirement, there were just two technicians running the clinic.

Stewart Mann succeeded Ponty in 1986 as the physician in charge.  At that time Tim Maling was providing a weekly session, and on arrival Stewart found that the clinic had diminished in size considerably since Ponty's time there.  There were two technicians, initially Lenore Duffy and Ruth Clegg, who were replaced by Marion Montgomerie and Melva Gould in 1988.

Initially, Stewart was seeing a variety of patients, from young persons with borderline hypertension referred with the question "is treatment required?", to the complicated or resistant hypertensive whose GP was having difficulty gaining control of blood pressure.  For a time, Stewart had access to some newer agents not available to GPs, but in time this differential disappeared.

Melva Gould and Marion Montgomerie in the clinic office in 1989.

Technician-only follow-up for stable patients was introduced, with Stewart reporting to both GP and patient after review of the chart.  A small amount of research was undertaken including a Consumer Institute intiative to compare various available automatic sphygmomanometers.

In time fewer and fewer patients were referred and the two technicians, Marion and Melva, spent some of their time helping out the cardiology technicians.

Tim Maling's interests switched to patients with syncope and hypotension.

Eventually hypertension clinic numbers dropped to a point where it could no longer be justified to employ technicians and Marion and Melva moved to cardiology full-time.

Stewart continued to be referred the odd patient with problematic hypertension but the hypertension clinic effectively ceased to exist by 2002.