In Memoriam Patrick J. Mulrow, <scp>MD</scp> (1926–2015)

Nearly five decades ago, Dr Patrick Mulrow was one of the key advisors to the National Institutes of Health (NIH) regarding the establishment of the National High Blood Pressure Education Program (NHBPEP). He attended the landmark meeting at the Aryle House hosted by Dr Ted Cooper, which planned the national campaign to detect, treat, and control hypertension. Early in his career he knew the importance of leaving his lab to devote time to translating research to practice and this was the objective of the NHBPEP. Through the years, Pat served on several NHBPEP working groups and education programs and chaired several NIH committees. But it was working with him as Executive Director of the World Hypertension League that I got to know him and witness what he could do. Patrick J. Murrow died on December 3, 2015, of an apparent heart attack in Jupiter, Florida. Pat was born and raised in New York City. He was a graduate of Cornell University Medical College and did his internship, residency, and postdoctoral fellowship in physiology at New York Hospital. He extended his education as an Endocrinology Fellow at Stanford University Medical School. After training he went to Yale University, first as instructor then quickly rose through the academic ranks to become Professor of Medicine and Chief of the Endocrine Section and Director of the Clinical Research Center. While at Yale, he was visiting scientist of biochemistry and pharmacology at Cambridge University and the University of Heidelberg, which must have sparked his later interest in work abroad. It was at Yale that his work on aldosterone and the role of the kidney in the renin-angiotensin system emerged and then flourished. He published extensively, having more than 250 publications to his name. He was an admired mentor and teacher to dozens of fellows. He then moved on to the Medical College of Ohio (MCO) as Professor and Chairman of the Department of Medicine where his talents were appreciated for two decades. The College of Medicine grew from 10 to 60 staffers during his tenure. Beginning at Yale, then at MCO, Pat became actively involved and served in a leadership capacity or as a member of the executive committee or board of directors for many national professional societies and associations including Chairman of the American Heart Association's Council for High Blood Pressure Research, Chairman of the Medical Research Council in Canada, President of the Central Society for Clinical Research, member of the US National Research Council, and Member Board of Directors of the Inter-American Society of Hypertension. Among his many awards and recognitions, he received the highly coveted American Heart Association Irvine Page-Alva Bradley Lifetime Achievement Award from the Council for High Blood Pressure Research Committee, the Humboldt Senior Scientist Award from the Humboldt Foundation Germany, and the Legacy Achievement Award. He was also recognized by the Royal College of Physicians of Ireland and was listed in Who's Who in Medicine and Healthcare. For nearly four decades his work was supported by NIH research grants. In 1995, Dr Mulrow was elected as Secretary General of the World Hypertension League (WHL) and maintained that position for 10 years. I had the assignment to work with the WHL during his tenure and the opportunity to interact with him as the League began to expand its worldwide programs. Pat's interest in aldosterone encouraged activities related to population-based salt reduction. From his clinical days, he knew firsthand the ravages of uncontrolled hypertension, much of which was driven by excessive salt consumption. As a method to prevent the rise in blood pressure in populations, the international movement to lower salt in the food supply was promoted early on by the WHL. The activity gave traction to the World Action on Salt and Health program and other population-based salt reductions throughout the world. Rather than reinvent the wheel, Pat saw another opportunity to expand the WHL portfolio by adapting then promoting the NHBPEP Working Group Report on Primary Prevention of Hypertension to member nations of WHL. The continued inclusion of encouraging treatment and then, in addition, expanding activities for prevention of raised arterial blood pressure, was a paradigm shift for the League. The additional focus was attractive to many WHL member nations as the cost of medical care to treat hypertension was beyond the reach of many people throughout the world. In this same vein, the League developed a plan to reverse the growing global epidemic of obesity. As an endocrinologist, he could appreciate, more than most, how obesity raised the risk of diabetes as well as hypertension and cardiovascular disease. Landmark WHL meetings were held in Prague and Washington, DC, to develop strategies for member nations to address this important heart and vascular disease risk factor. During his tenure, the WHL Web site was expanded and a variety of hypertension position papers were published. The bibliography of WHL's publications focusing on population health includes 15 entries. Pat was persistent and persuasive to get member nations to act. His pleasant and easygoing personality helped bring in a variety of nation representatives to WHL and have them work together as one body. He built on the foundation of WHL set by Dr Tom Strasser and others, and, during his watch, WHL grew in size and effectiveness. Dr Myron Weinberger, from Indiana University, was a colleague and friend and wished to be included in the memories. “I first met Patrick Mulrow at the Endocrine Society meeting in Miami, Florida, in 1967 when I made my first scientific presentation as a Research Fellow at Stanford University with Dr John Luetscher. Pat had been one of Luetscher's Fellows at Stanford a few years earlier and had also worked with Dr Fran Ganong in aldosterone research at the University of California, San Francisco. He continued his career at Yale University and MCO. We met frequently at the major meetings for endocrinologists and hypertensionologists and shared our common scientific interests over the years. Pat was a superb scientist and was always interested in the observations of others. Beyond our mutual scientific interests, we also had many opportunities to establish friendships, which included both of our wives, and to travel together. After many of these meetings I particularly recall evenings of piano playing and song as well as tennis matches in which neither of us was willing to yield to the superior athletic talents of the other, leading to some long and tiring matches! I was privileged to call Pat my friend and will miss him greatly.” Dr Robert Carey, from the University of Virginia, had the following to add: “Pat J. Mulrow was an extraordinary endocrinologist as well as a quintessential clinical scientist in an era of rapid advances in our knowledge of control of body fluid volume and blood pressure. His 1957 paper in the Journal of Clinical Investigation led the way to the importance of dietary potassium and dietary sodium restriction as having important and opposite actions in the control of aldosterone secretion. Pat was at the forefront of the concept that the enzyme renin could be produced in organs other than the kidney and was the first to identify a complete, independent renin-angiotensin system within the adrenal glands. He used impeccable science to validate many novel concepts in cardiovascular endocrinology, which provided the foundation of our knowledge today. More importantly, he was a superb mentor and friend for countless physicians and scientists at the University of Toledo and throughout the country. Pat was an academic giant that, through his warmth, geniality, and genuine caring, had a major positive influence on me. His sense of humor was unforgettable. For knowing Pat, I will always be grateful.” Dr Edward Frohlich, Ochsner Clinic adds: It is clear that through Dr Mulrow's many leadership efforts, the gains achieved over his lifetime have importantly supported his interest worldwide in advancing knowledge about hypertension and improved interest by clinicians for the treatment of hypertensive diseases. Surely, the health of mankind has markedly improved through Dr Mulrow's worldwide efforts in addition to his contributions in the organizations and the many societal activities in which he and his academic colleagues contributed. Each of the above medical leaders is representative of his colleagues and coworkers who speak to his contributions as an investigator, clinician, and teacher and to his international leadership role in hypertension. I, as well as many national hypertension leaders, sincerely appreciate Dr Mulrow's nicely done work in increasing the knowledge base regarding the mosaic of raised arterial blood pressure and the growth, activities, and effectiveness of the WHL. Pat, for your wonderful personality, your thinking, and your energy and for all you have done to prevent and treat a very important global health problem, we are grateful and say thank you. To your loving wife Jacquelyn and your children, I ask you to accept my heartfelt sympathy and condolences.

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