Horace Smirk, a major figure in hypertension research, was born in Lancashire and remained proud of his Lancashire origins. He had a brilliant undergraduate career and this launched him into various research scholarships and grants. In 1932 he was awarded a Beit Memorial Fellowship, which he used for a three-year period of research at University College Hospital under TR Elliot and Sir Thomas Lewis. With colleagues such as McMichael, Pickering, Wayne and Himsworth, this was a stimulating experience and it showed him what could be done by a combination of clinical and laboratory research. In 1936 he took up the chair of pharmacology in Cairo, in succession to JH Gaddum. This post included care of patients and it was during this period that he became interested in hypertension and the variability of blood pressure.

In 1939, he was appointed to the chair of medicine at the University of Otago, Dunedin, New Zealand, arriving there in 1940 with his wife Aileen, two small children (two more were born later), a mass of blood pressure data and samples of many different drugs among which he hoped to find some that would be clinically useful in lowering blood pressure. In spite of a heavy teaching load, wartime shortages and very few staff, he continued his research and developed his ‘multifactorial hypothesis’ of hypertension. This hypothesis was that early elevations of blood pressure are physiological rather than pathological, that a raised blood pressure is followed in time by pathological changes in the blood vessels and that these lead, in a vicious circle, to further rises in pressure.

At this stage, then, he was convinced that high blood pressure itself is damaging, he was very knowledgeable concerning the behaviour of the blood pressure in different situations and he was actively searching for drugs that would lower high blood pressure. During a period of sabbatical leave in London in 1949, he naturally became interested in the discovery of the effects of hexamethonium and he brought supplies of this drug with him when he returned to Dunedin. Like others, he quickly confirmed the hypotensive effects but, unlike many, he was not put off by the side effects. By a combination of meticulous attention to detail of dosage and advice to patients, and by his enthusiasm and confidence, he made the regimen work and obtained very good results. His use of technicians to record blood pressure throughout the day played a big part in this.

His work with the improved ganglion blocker pentolinium was fundamental in overcoming much of the widely held early suspicion of antihypertensive therapy. In a series of papers in the early 1950s, he was able to report that left ventricular failure could be relieved by lowering the blood pressure, without the use of digitalis or diuretics, and that severe retinopathy could be made to regress. He became a world authority on antihypertensive treatment and was much in demand as a speaker. In 1957, his book High Arterial Pressure was published; according to his wife, in order to write the book, he used to set the alarm for 4 am each morning for a year. He was a man of tremendous energy and drive.

He was particularly interested in neurogenic and vascular aspects of hypertension and was keen to find an animal model of hypertension that was neither renal nor endocrine. By 1958, he was successful in developing, by selection and in-breeding, the first strain of genetically hypertensive rats, later to be emulated by others. These rat strains have contributed enormously to our knowledge of hypertension.

His efforts to discover a new antihypertensive agent were unsuccessful but did turn up an iminazole, amarin, which sensitised the heart of an anaesthetised experimental animal to the effects of adrenalin or electrical stimulation, leading to the ‘R-on-T’ phenomenon and ventricular fibrillation. He went on to show that the R-on-T phenomenon occurred also in man and could lead to sudden death. He was ahead of his time in this work.

He was made a Fellow of the RACP in September 1940 and was Vice-President of the College from 1958 to 1960. He was a member of the New Zealand Board of Censors (and later Senior Censor) from 1940 to 1958 and was a member of the Medical Research Council of New Zealand for many years. He held numerous guest lectureships, sat on several WHO advisory committees, was a Life Member of the New York Academy of Science and was an Honorary Overseas Member of the Association of Physicians of Great Britain and Ireland and the Cardiological Society of India.

He was knighted in 1958. In 1962, the Wellcome Foundation recognised his contributions by granting £120 000 to the University of Otago to build the Wellcome Medical Research Institute with him (now Professor of Experimental Medicine) as first director. He ended his career with a flourish when, at the age of nearly 70, he presented five papers at a large symposium in Philadelphia.

He was a tall man, always on the move, shrewd, bold, determined and hugely enthusiastic. He had an infinite capacity for work, a restless and enquiring mind and considerable panache and style. He was a founder member of the group that subsequently grew into the International Society of Hypertension and he enjoyed his many international contacts. He liked to read the writings of the philosophers, Montaigne being his favourite. He had a long and happy marriage and the Smirks were a close-knit family. Sadly, cerebrovascular complications set in, an irony of fate in view of his life’s work to prevent vascular problems. During this long period of ill health, he was devotedly cared for by his wife, who predeceased him, and by his family.