Franklin D. Roosevelt and the Silent Killer

Recently, the American Heart Association and the American College of Cardiology jointly released updated guidelines regarding the management of high blood pressure.

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It once again made me think back on the history of blood pressure management in this country, and how far we have come. In the early 20th century, high blood pressure was considered an inevitable part of aging—so much so that it was sometimes referred to as "essential hypertension," implying it was essential to life itself. There were no reliable treatments, and many physicians actually believed that trying to lower blood pressure might be more dangerous than letting it run its course.

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If you can believe it, this apathetic approach to the management of blood pressure cost this country the life of one of the most influential presidents in history: Franklin Delano Roosevelt. 

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FDR was America’s longest-serving president and led the fight against the country’s enemies in World War II—but behind the scenes, he was unknowingly battling a different enemy: high blood pressure. 

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Throughout the 1930s–early 1940s, FDR's blood pressure was reportedly in the range of 140–150 mmHg systolic. While this would be classified as hypertension today, it was definitely not considered alarming at the time.

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However, in the summer of 1944, during his campaign to serve an unprecedented fourth term at the height of World War II, the president had appeared frail and fatigued. At the request of his personal physician, Admiral Ross T. McIntire, several doctors examined the president. 

One of these doctors, Dr. Frank Lahey of Boston, subsequently wrote in a confidential memo that he had informed Admiral McIntire of his personal doubt that the president could survive another four years. Lahey explained that the president had likely been on the verge of heart failure in recent months as a result of high blood pressure.

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But despite clear physical decline—including rapid weight loss and breathlessness—his doctors remained publicly vague about the severity of his condition. 

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In August 1944, FDR was documented as having chest pain while giving a campaign speech on a naval ship. In the captain's quarters, he complained of severe, crushing pain for 15 minutes. His ECG and white blood cell count showed that he was not having a heart attack. In hindsight, he was experiencing angina, likely from severe hypertension.

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Six months later, in February 1945 during the Yalta Conference, FDR was audibly wheezing and unable to complete sentences in radio addresses. His reported blood pressure at that time approached 250/150mmHg! 

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One month later, in March 1945, FDR became ill, and Dr. Howard Bruenn, a cardiologist, was asked to examine the president. Dr. Bruenn listened to FDR’s lungs, and heard evidence of fluid build-up during a physical examination. A chest x-ray film showed pulmonary edema (fluid buildup) and evidence of an “enlarged heart.”  The ECG also suggested evidence of “LVH” which is thickening of the muscle of the heart, usually occurring in response to hypertension. His kidneys were also being affected, as his urinalysis revealed high levels of protein in the urine (which should not have been there).

It was clear that FDR was suffering from Congestive Heart Failure. Dr. Bruenn initiated treatment with Digitalis (a medication that helps the heart pump harder, and was one of the few cardiac medications used at the time), a low-salt diet, a reduction in alcohol and cigarette use, and bed rest. 

Within a week, FDR was no longer symptomatic. 

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But just one month later, in April 1945, and just nine months after Dr. Lahey wrote his initial memo, President Roosevelt died. 

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He had returned to Warm Springs, Georgia, a destination that had served since the 1920s as his favorite retreat. On April 12, 1945 while sitting for a portrait, he collapsed and fell unconscious. Astoundingly, Dr. Bruenn estimated FDR's blood pressure to be 350/195 mm Hg. 

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The official cause of death was listed as a "massive cerebral hemorrhage," brought on by long-standing, uncontrolled hypertension.

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In retrospect, FDR had what we now call hypertensive heart disease. FDR's physicians did document signs of congestive heart failure—swelling in the legs, shortness of breath, fatigue—but the understanding of heart failure as a progressive and treatable condition was still rudimentary. Diagnostic tools that we now take for granted—like echocardiography, blood tests, or coronary angiography—were nonexistent.

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FDR’s tragic cardiovascular decline had far-reaching consequences—not just medically but politically. Despite his failing health, he continued to shoulder enormous stress, including travel, decision-making, and wartime leadership, without the benefit of modern medical interventions. His death thrust an unprepared Harry Truman into office during a critical moment in global history. Yet his story galvanized future interest in understanding and managing hypertension.

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In the 1950s and 1960s, spurred by cases like FDR’s, hypertension research accelerated. The Framingham Heart Study began to quantify the dangers of high blood pressure, and the development of the first antihypertensive medications revolutionized cardiology. But the first mainstream anti-hypertensive medications, β-blockers and diuretics, did not become available until the 1950s, too late for FDR.

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Recently, the American Heart Association and the American College of Cardiology jointly released updated guidelines regarding the management of high blood pressure. These guidelines emphasize the following:

• A blood pressure of ≥130/80 mmHg increases risk for heart failure, stroke, and kidney disease.
• Home blood pressure monitoring is a key tool to improve rates of blood pressure control
• Lifestyle changes (diet, exercise, sodium restriction) can significantly reduce cardiovascular risk.
• Early detection and consistent monitoring are critical. Silent damage from hypertension can begin years before symptoms arise.
  
  

These updated guidelines are the result of decades of intensive research dedicated to reducing the impact that high blood pressure has on our health. We now live in an era where hypertension can be identified, managed, and treated.

FDR’s life and death remain a turning point in both American politics and medical history, contributing a sobering look at the toll of uncontrolled hypertension and underscores how far cardiology has come—and how far we still have to go. 

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At Wisconsin Cardiology Associates, we counsel our patients to aim for a healthy, plant-based diet, emphasizing fruits, vegetables, beans, lentils, whole grains and nuts. Have questions about the best way you can prevent heart disease? Call us and make an appointment for a consultation.

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References:

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Bishop, T et al. West J Med. 2001 Aug;175(2):119–124.

Jones, DW, et al. "2025 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults." online, 14 August 2025

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