Armando Susmano
Chicago, Illinois, United States

On April 12, 1945, the country was shocked to learn their recently-elected fourth-term president was dead.

Yet even after FDR’s death, Roosevelt’s personal physician, Admiral Dr. Ross McIntire wrote that “FDR’s blood pressure and heart signs have been normal.”¹ The president’s medical records were kept in a safe at Bethesda Medical Hospital in Maryland, but the records disappeared right after his death. Since Dr. McIntire was one of three people with access to the safe, “historians have accused Dr. McIntire of destroying FDR’s medical records in order to hide his misdiagnosis and mismanagement of the president’s case.”¹

While Franklin D. Roosevelt ran for his fourth term in March 1944, Harry Truman, his vice presidential choice, voiced “[concern] about FDR’s unhealthy appearance.”^2–3 However, Dr. Ross (an ear, nose, and throat specialist) announced to the nation that the president “was enjoying excellent health.”

FDR was found to have systolic hypertension in 1937 and diastolic hypertension in 1941, but the diagnoses were disguised under various aliases.⁴ In May 1941, under the pseudonym F. David Rolph, he was found to have severe iron deficiency anemia with hemoglobin levels of 4.5 gm/100 cc. The anemia rapidly responded to iron replacement, but amazingly he never had any cardiac symptoms secondary to the severe anemia. His hematocrit was 31, and presumably either the hemoglobin level or the hematocrit could have been a lab error.

Roosevelt also had been known to have mild proteinuria starting in 1939, which became worse by 1944 when it was 4+, though it was documented under the name Mr. John Cash.⁴ FDR’s family became unhappy with Dr. McIntire’s handling of his case, requesting a second opinion and consultation with a young navy cardiologist, Dr. Howard Bruenn.

On March 27, 1944, Dr. Bruenn found FDR to be cyanotic, breathless, with rales in his lungs, left ventricular enlargement, a booming aortic sound, a blowing apical systolic murmur, and a blood pressure of 186/108 mm Hg.² His blood pressure, which had been at 188/105 on February 27, 1941, was not rechecked until 1944.³ He diagnosed hypertensive heart disease, congestive heart failure, and acute bronchitis. He prescribed digitalis, a low sodium and weight reduction diet, bed rest with up to 10 hours of sleep, curtailing his cigarette smoking, codeine for cough control, and general sedation.

A week later he was better and could lay flat in bed without dyspnea, but his blood pressure was still high at 210/110 mm Hg.¹ One month later he had a bout of acute cholecystitis, and a cholecystogram done on May 26, 1944 showed a well-functioning gall bladder with cholesterol stones.

He won re-election in November 1944, and in January 1945, during his State of the Union speech to Congress, had a severe chest pain lasting 15 minutes. His EKG remained unchanged from previous ones, and there was no evidence of a myocardial infarction. Despite the high level of hypertension he went to Yalta in February of 1945 for the famous meeting with Churchill and Stalin. His blood pressure there was up to 260/150 mm Hg, and pulsus alternans was noted for the first time.

Eight weeks later while reading his mail, he had a sharp and severe pain in the back of his head. Within two minutes he collapsed and became unconscious due to a massive cerebral hemorrhage that would take his life two hours later. His blood pressure that morning was in excess of 300 mm Hg systolic and 190 mm Hg diastolic.²

The cause of FDR’s malignant hypertension remains unknown. Was it renovascular or due to other causes? An autopsy was never done. According to Dr. Bruenn he had no evidence of renal dysfunction and had only one episode of coronary insufficiency without a myocardial infarction.²

During his presidency hypertension was not considered a treatable disease. Options for treatment were extremely limited; and the general idea among physicians was that normally blood pressure increases with age. In his paper entitled “Clinical Notes on the Illness and Death of President FDR,” Dr. Bruenn stated, “I have often wondered what a turn the subsequent causes of history may have taken if the modern methods for the control of hypertension had been available then.”²

FDR represents a unique and superb example of the natural history of untreated hypertension and the complications that can arise if left untreated. One wonders how his heart was able to tolerate such extremely elevated blood pressure for so many years without going into an acute heart failure. Today, hypertension may not be a curable disease, but it is definitely a “treatable disease.”⁵

Notes

1. Health Media Lab, “Franklin Delano Roosevelt (1933–1945): The Dying President,” Health Media Lab (2004), http://www.healthmedialab.com/html/president/roosevelt.html.
2. Howard G. Bruenn, “Clinical Notes On The Illness and Death of President Franklin D. Roosevelt,” Ann. of Int. Med. 72 (1970): 579–59.
3. Jean Edward Smith, Franklin Roosevelt:A Biography (New York: Random House, 2007), 600–636.
4. Doctor Zebra, “The Health and Medical History of President Franklin Roosevelt,” Doctor Zebra (October 2006).
5. Richard J. Bing, “Franklin Delano Roosevelt and the Treatment of Hypertension: Matters at Heart.” Dialogues in Cardiovascular Medicine 12, no. 2 (2007): 133–135.