Björn Folkow, for many years Professor and Head of the Department of Physiology at the University of Göteborg, Sweden, passed away on 23rd July at the age of 91 after a short illness. He is survived by his wife Biørg and 6 children, one of whom is Professor of Physiology at the Universiy of Tromsø, Norway. Björn Folkow has been an outstanding figure in hypertension research for over fifty years.
This more than an obituary wants to be a personal recollection of a man and a friend from whom I took lifelong inspiration as from an older brother. Björn Folkow started as a brilliant physiologist, who then became fascinated by the insight physiological knowledge and methodologies could offer to medicine, particularly to the pathophysiology and treatment of hypertension, and continued to provide fundamental contributions to the understanding of clinical hypertension. I also started as a physiologist, who became fascinated by the physiological approach to clinical investigation, and decided to become a physician in order to be able to use this approach, so to say, in real life.
As was usual about fifty years ago, when travelling was difficult and expensive and there were less numerous opportunities for meeting, Björn and I first met in libraries, that is by reading and studying each other's published papers. These were times when reading was done in libraries, rather than on computers, and I remember well the hours I spent in reading the series of brilliant papers that the Stockholm group of physiologists headed by Björn Uvnäs and Björn Folkow was publishing on Acta Physiologica Scandinavica about the effects of topical electrical stimulation of the hypothalamus. Influenced by my two mentors, Giuseppe Moruzzi and Cesare Bartorelli, one of whom had worked with Ranson and Magoun, the other with Walter Rudolph Hess, pioneers in experimental stimulation of the hypothalamus, I was also interested on cardiovascular regulation by the higher nervous system and was working on baroreflex regulation of the same hypothalamic areas Björn Folkow was directly stimulating.
Finally, a happy occasion for meeting personally came in 1960 when Jan Brod with the support of the World Health Organization organized a memorable symposium in Prague on “The Pathogenesis of Arterial Hypertension”, to which the major scientists in the area of experimental and clinical hypertension were invited, with the unspoken intention to facilitate contacts and interactions between scientists from the West and the East in those difficult years of the Cold War. Björn Folkow, who had just been named Professor of Physiology at the University of Göteborg, was obviously invited, and I was also invited, probably the youngest and the least renowned of the group. This was indeed the first hypertension meeting I ever attended. Björn made an excellent presentation on haemodynamic responses to hypothalamic stimulation, and I summarized our ongoing work on reflex mechanisms regulating hypothalamic activity and emotional behaviour. Björn's lovely wife Biørg was also in Prague, and so was my wife, and that was the beginning of a long friendship and intellectual collaboration between us, which grew even tighter with the birth and development of the European Society of Hypertension. To all the early meetings of ESH held in Milan, Björn Folkow was much more than an illustrious attendant (Björn picture on top of this obituary comes from one of those early meetings), he was the inspiring scientific personality, so it was too obvious that when in 1989 the young Society decided to have an award lecture at the centre of its meeting, the award, generously funded by AstraZeneca, was named after Björn Folkow. Since then eighteen renowned scientists have been awarded by ESH in the name of Björn.
I have another lovely recollection of my relations with Björn. Years ago he invited me to lecture at his University in Göteborg, and for several days I had the pleasure of staying with his wife and family in their beautiful house. One early morning he took me to his preferred sport activity, fishing. It was the beginning of March, the right time – he mentioned – for the passage of sea trouts. It was still very cold on the North Sea coast at that time of the year, and my fingers soon became frozen and unable even to turn the crank for recovering the line, and eventually the trout. Björn pleasantly teased me about my clumsy behaviour, but then the professor of physiology came to my rescue with the explanation that it was well known that periarticular fat composition of flabby Mediterranean people was different and with a higher freezing point than periarticular fat of Viking sailors.
Björn Folkow's insight into scientific and medical problems was exceptional. In the last several decades, while physiology and more broadly medicine, thanks to unbelievable advances in scientific technologies, were getting more and more involved into the understanding of cellular and molecular mechanisms of selected isolated phenomena, Björn was one of the last examples of an illustrious line of scientists, such as Claude Bérnard, Sherrington or Cannon, that were able to see the connections, to integrate the information, to have a vision. Moving from an initial experience as a brilliant physiologist of the autonomic nervous system, he became more and more interested in the adaptive responses of the target of autonomic activity, small arteries walls, and elaborated a fascinating hypothesis of the pathogenesis of hypertension, by which a perturbance in any of the various cardiovascular regulator mechanims (of which he studied the neural mechanisms most) could entertain a self-maintained, persistent state of vasoconstriction (increase in wall to lumen ratio), through vascular structural changes enduring even when the initiating perturbance did not persist. The importance that assessment of cardiovascular and renal damage is now given by hypertension guidelines, such as those of the European Societies of Hypertension and Cardiology, for stratifying risk, refining prognosis and guiding treatment of hypertensive patients, is thus an heritage of Folkow's inspiration and witnesses the enduring influence of his thought.
The disappearance of Björn Folkow is a great loss to the whole community of hypertension investigators. He was respected teacher of many of them, not only physiologists, but experimental and clinical phamacologists, clinical researchers and clinicians, who all feel orphan of his intellectual guidance and friendly support.