John Laragh, Hypertension-Therapy Pioneer, Dead at 90

March 25, 2015

PALM BEACH, FL — Clinician-researcher Dr John H Laragh died March 20 at age 90, according to published reports here[1]. Laragh, who directed the cardiovascular center at New York Presbyterian Hospital-Weill Cornell Medical Center, is credited with discoveries during the 1960s involving the renin-angiotensin system (RAS) and its role in hypertension and vascular disease leading to MI, stroke, and renal failure. His work, which only slowly gained acceptance among physicians, also helped explain the capacity for beta-blockers, eventually a mainstay antihypertensive therapy, to help control high blood pressure.

Later he would become embroiled in controversies over the broad generalizability of diuretics and RAS inhibitors as antihypertensive agents and politics involving the American Society of Hypertension (ASH) and the American Journal of Hypertension(AJH), both of which he helped launch.

"Dr Laragh was a larger-than-life character who in his day was undoubtedly the best-known name in hypertension in the world, both inside and outside of the profession. His research contributed greatly to innovations in treatment," Dr Samuel J Mann, who previously worked under Laragh, told heartwire from Medscape in an email.

"Obtaining acceptance of and adherence to his views was a decades-long battle," he said. "What he stood for offered a tremendous advance in the approach to treating hypertension that remains valid today."

In a testimonial published last year[2], Dr Michael A Weber (SUNY Downstate College of Medicine, Brooklyn, NY), summarized Laragh's groundbreaking research. "John and his group provided evidence that inappropriately high plasma levels of renin in patients with hypertension were associated with an increased risk of myocardial infarction and other outcomes," he wrote.

"Over time, this discovery became progressively broadened and led to the recognition that excess activity of the renin-angiotensin system is an adverse factor in several forms of cardiovascular and renal disease."

Laragh's group, Weber continued, also found that "that the efficacy of antihypertensive treatment with a beta-blocker was largely dependent on the drug's ability to reduce plasma renin activity. This sentinel observation demonstrated that the renin-angiotensin system plays a causative role in blood-pressure elevations in a large proportion of patients with hypertension."

Based on their work, he and his wife and research collaborator, Dr Jean E Sealey (New York Hospital/Cornell University Medical Center, NY), a biochemist and physiologist, advanced the idea that hypertension is caused "either by an excess of renin, in about 65% of cases, or by a sensitivity to sodium, in about 35%," as described by heartwire in 2003. Any given case of hypertension, they said, relates to one or the other of these basic problems, and treatment for one type of hypertension will be ineffective for the other.

In 2010, heartwire noted that Laragh was the first to "advocate the measurement of plasma renin activity to match the characteristics of an individual's hypertension, an idea that was largely rejected by practicing physicians at the time."

As the first president of ASH and founding editor of the AJH, Laragh curated a close relationship between the society and journal, which deteriorated and ultimately dissolved in 2005, in large part because of his allegations of inappropriate financial ties between ASH and industry.

"He singled out the continuing-medical-education symposia that societies often hold in conjunction with their medical meetings," the Wall Street Journal reported at the time[3]. "Dr Laragh said the organization's continuing-medical-education agenda had become 'unacceptably dominated' by members who are 'heavily involved in pharma marketing for personal gain.' "

Laragh was recognized for his contributions to medicine by appearing on the January 13, 1975 cover of Time magazine.


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