In 'Mad Men, '60s treatment of high blood pressure seems advanced

The premise: It's 1963, and Don Draper (Jon Hamm), a 36-year-old creative director for Sterling Cooper advertising agency, needs a physical. He visits his regular physician, whom he hasn't seen in "quite some time," acknowledging that he has a high-tension job and that he consumes five alcoholic drinks and two packs of cigarettes per day. The doctor discovers that Draper has high blood pressure. He starts Draper on reserpine to bring down his blood pressure and phenobarbital to help him relax, but he doesn't explain potential side effects, including depression or erectile dysfunction. In a subsequent scene, Draper appears unable to perform sexually with his wife, Betty (January Jones).

The medical questions: Would a 1960s physician have treated a blood pressure elevation immediately? Was reserpine a common first-line treatment for hypertension in the 1960s? Would depression and sexual dysfunction have been considered as potential side effects? Was phenobarbital commonly used to treat stress? Were the effects of cigarettes on overall health known?

The reality: "Many hypertension experts in the early 1960s were still saying that elevated blood pressure wasn't bad for you and that reducing it could cause damage to important organs such as strokes and heart attacks," says Dr. Suzanne Oparil, director of the vascular biology and hypertension program at the University of Alabama School of Medicine. Dr. Henry Black, president of the American Society of Hypertension, points out that some experts at the time were even insisting that blood pressure elevation was an "essential" compensation for having stiff arteries and was necessary to get blood to the heart, brain and kidneys. The original Veterans Administration (now Veterans Affairs) study showing the benefits of anti-hypertensive treatment (reducing the risk of strokes, kidney disease and aneurysms) wasn't published until 1967.

Before then, the smarter doctors anticipated those benefits and aggressively treated elevated blood pressure promptly, but there were no clinical guidelines set.

Draper's doctor does seem smart, Black says, but he adds that "even now we don't consider the diagnosis of hypertension established unless you've had elevated readings three times separated by at least a week. In those days they would have been even more cautious and not started treatment right away."