hypertension is an important worldwide health challenge and is known as a leading risk factor for mortality . present - day knowledge on hypertension is clearly indebted to the previous efforts made in this field . the first description of blood pressure in the modern era was made by stephen hales in 1733 . very early description of hypertension as a disease is attributed to thomas young in 1808 . the invention of the cuff - based sphygmomanometer was done by scipione riva - rocci in 1896 and made the easy measurement of blood pressure in the clinic possible . despite the well - known history of hypertension research in the modern era , main points in the medieval concept of this disease and its early management methods remain obscure . this article attempts to make a brief review on the medieval origin of the concept of this disease from the hidayat of al - akhawayni ( ? al - akhawayni bukhari ( ab bakr rab , ibn - e - ahmad akhawayn bukhr ) , also known as joveini , was a 10 century persian practitioner [ figure 1 ] . he was trained in medicine under the supervision of abu al - qasem maqanei , a rhazes ' follower . al - akhawayni was familiar with medical knowledge of his predecessors such as hippocrates , aristotle , galen , and rhazes . he has described different clinical findings in the field of neurology , psychiatry cardiology , and other fields of medicine for the first time . 2014;261(3):643 - 5 hidyat al - muta'allimin fi al - tibb ( the students ' handbook of medicine ) is the only known medical book that remained from al - akhawayni . the importance of this comprehensive medical encyclopedia is that it is the first text on medicine written in the persian language . the first part ( 51 chapters ) provides general information on the four basic humors ( akhlat ) human faculties ( qowa ) and pneumata ( arwah ) ( as the basis of the medieval physiologic science ) , and ancient anatomical points on different organs . in one of the hidayat 's chapter entitled  fi al - imtela ' ( about the fullness )  , akhawayni described a disease with manifestations similar to those related to what is known today as hypertension . in his opinion , the disease could result from the excessive amount of blood within the blood vessels . he believed that in patients with al - imtela ' , the total amount of blood is not normal . however , the quality is normal and could carry out its functions . according to al - akhawayni , al - imtela ' can manifest itself with symptoms including the presence of a pulsus magnus , sleepiness , weakness , and dyspnea . after these general descriptions , he explained the possibility of an acute event occurring with this disease as follows : when severe facial blushing , engorgement of the vessels [ superficially located in the head and the neck ] , and protrusion of the eyes occur ,  there is concern that a vessel [ of the brain ] becomes ruptured and uncontrollable bleeding occurs , or  sakteh [ stroke ] occurs  and there is the threat of death  ; epistaxis may occur   . it is noteworthy that al - akhawayni in discussing the causes of stroke in sakteh ( stroke ) chapter of hidayat described al - imtela ' as the etiology of hemorrhage within the cranial cavity . he also criticized rhazes ' ( 865 - 925 ad ) notion on hemorrhagic stroke . these aforementioned descriptions could correspond to an early explanation of hypertension , its crisis , and the associated hemorrhagic stroke . these include recommendations of changes in lifestyle and dietary program for patients ( comparable to the two mainstays of hypertension management in modern medicine ) . for example , he counseled staying away from anger and sexual intercourse , avoiding the consumption of wine , meat , and pastries , reducing the volume of food in a meal , and maintaining a low - energy diet ( ghalilol ghaza ) . in spite of some controversies , according to the current body of knowledge , anger , meat , carbohydrates , heavy alcohol intake , and high calorie foods are harmful to patients with hypertension . moreover , sexual activity in those patients can be associated with risk of cardiovascular events . the dietary usage of spinach and vinegar were two of al - akhawayni 's recommendations . at present , there is evidence which defends the benefits of such substances as a dietary complement for patients with hypertension . another important point is that al - akhawayni prohibited the addition of garlic to the diet of patients with intracranial hemorrhage . in modern medicine , it has been established that this herb has anticoagulant effects . along with the aforementioned methods for the long - term management of al - imtela ' , al - akhawayni recommended venesection ( phlebotomy in modern nomenclature ) as a therapy , especially in cases of sudden aggravation of disease . table 1 outlines the clinical presentation , life style modifications , and treatments suggested for al - imtela ( as described by akhawayni ) compared with those of modern medicine . comparison of clinical presentation , life style modifications , and treatments suggested for al - imtela ( as described by akhawayni ) and hypertension . physical basis of the concept of hypertension ( intravascular liquid pressure ) and the instruments needed for its measurement was not available during the medieval period . however , philosophical approach of the medieval scientists compensated their lack of physical knowledge and instruments in some cases . the definition and description of  al - imtela '  as a disease with multiple similarities with the current concept of hypertension can be explained under the light of this fact . the disease of  al - imtela '  was not described by akhawayni for the first time ; rather it has been mentioned by greek physicians such as galen and hippocrates . however , their description to this disease differed from akhawayni 's . this point shows that like other cases , al - akhawayni 's early description on the concept of hypertension was based on his clinical experiences as well as knowledge of his predecessors .
despite the well - known history of hypertension research in the modern era , like many other cardiovascular concepts , main points in the medieval concept of this disease and its early management methods remain obscure . 
 this article attempts to make a brief review on the medieval origin of the concept of this disease from the hidayat of al - akhawayni ( ? 
 -983 ad ) . 
 this article has reviewed the chapter of  fi al - imtela  ( about the fullness ) from the hidyat al - mutaallimin fi al - tibb ( the students ' handbook of medicine ) of al-akhawayni.the definition , symptoms and treatments presented for the imtela are compared with the current knowledge on hypertension . 
 akhawayni believed that imtela could result from the excessive amount of blood within the blood vessels . 
 it can manifest with symptoms including the presence of a pulsus magnus , sleepiness , weakness , dyspnea , facial blushing , engorgement of the vessels , thick urine , vascular rupture , and hemorrhagic stroke . 
 he also suggested some ways to manage al - imtela ' . 
 these include recommendations of changes in lifestyle ( staying away from anger and sexual intercourse ) and dietary program for patients ( avoiding the consumption of wine , meat , and pastries , reducing the volume of food in a meal , maintaining a low - energy diet and the dietary usage of spinach and vinegar ) . 
 al - akhawayni 's description of  imtela ,  despite of its numerous differences with current knowledge of hypertension , can be considered as medieval origin of the concept of hypertension .