View Professor Paul Korner (1925-2012)'s photo gallery
You can order the DVD from the Academy for $15 (including GST and postage)
Professor Paul Korner was interviewed in 2008 for the Interviews with Australian scientists series. By viewing the interviews in this series, or reading the transcripts and extracts, your students can begin to appreciate Australia's contribution to the growth of scientific knowledge.
The following summary of Korner's career sets the context for the extract chosen for these teachers notes. The extract discusses the causes of hypertension (high blood pressure) as described in his 2007 book. Use the focus questions that accompany the extract to promote discussion among your students.
Paul Korner was born in Moravská Ostrava, in the former Czechoslovakia, in 1925. Due to increasing political unrest, he and his family left Czechoslovakia in 1938 and immigrated to Sydney in 1939.
Korner enrolled in medicine at the University of Sydney but interrupted his studies to do research in exercise physiology; and received a BSc in 1946 and an MSc in 1947. He returned to medical studies and was awarded a Bachelor of Medicine and Bachelor of Surgery in 1951. After one year as a junior hospital resident, Korner decided to pursue research as a career. He was a National Health and Medical Research Council junior research fellow at the Kanematsu Memorial Institute of Pathology (1952–1953) and an overseas research fellow with the Life Insurance Medical Research Fund of Australia and New Zealand (1954–1956). In 1956 he was awarded a Doctor of Medicine from the University of Sydney.
From 1956 to 1959, Korner was a senior lecturer in physiology at the University of Sydney and then associate professor of cardiopulmonary physiology (1959–60). In 1960 he became foundation professor of physiology at the University of New South Wales and was there until 1968.
Korner returned to the University of Sydney in 1968 as Scandrett Professor of cardiology and head of the Hallstrom Institute of Cardiology at the Royal Prince Alfred Hospital until 1974. He helped establish a coronary care unit and a hypertension unit at the hospital, did pioneering research into the regulation of blood pressure and worked on curriculum development for the medical school.
In 1975 Korner became director of the Baker Medical Research Institute and professor of medicine at Monash University, positions he held until 1990. During his directorship, the Baker Medical Research Institute became Australia's first institute dedicated entirely to cardiovascular research.
Since 1991, Korner has been emeritus professor at Monash University, emeritus director at the Baker Medical Research Institute and visiting professor at the University of New South Wales. In 2007, he authored Essential Hypertension and Its Causes: Neural and Non-Neural Mechanisms, a book which analyses the genetic and environmental causes of high blood pressure and describes mechanisms the body uses to control and elevate blood pressure.
Korner's awards and honours include the Edgeworth David Medal (Royal Society of New South Wales, 1958), RT Hall Prize (Cardiac Society of Australia & New Zealand, 1970) and the Advance Australia Award (1989). He was made an Officer of the Order of Australia in 1990 and received the Australia Centenary Medal in 2001.
Korner was elected a Fellow of the Australian Academy of Science in 1974.
But summarise, if you can: what is the essence that comes out of the book?
The essence of it is that mental stress is one of the really important drivers of essential hypertension. The three important things are mental stress, high-salt intake and obesity. But stress is often the initiator. It works through the central nervous system initially. The cortex perceives, 'Is it stress, is it severe stress? Can I do something about it?' If there is a lot of doubt and uncertainty in the system, you get what is called the defence response. That basically gets you ready to kick somebody into the moosh, or run away, whichever is the wisest thing to do.
Everybody gets stress and everybody gets this kind of response, so what is different about hypertension? In hypertension, what happens is that the stress behaves like a memory neurone. The brain somehow remembers the stress and it sensitises some of the connections between the cortex and the hypothalamus so that very low levels of stress, levels that most people wouldn't regard as stressful, actually give you this response. Once you've got that, it stays with you for a long time because there are changes in your synaptic structure. The person, who discovered this, was the Nobel Prize winner in the year 2000, Eric Kandel. I had been reading some of his work before he received the Nobel Prize and thought 'this must really about be it'. There is not much evidence in the literature, but there is quite compelling evidence in the literature that that is how it really works, that gives you permanent hypertension.
Thanks to Murray, we found out that in people with mild hypertension you get your maximum neural activity at that point of time. So, as blood pressure keeps going up in the course of a normal untreated hypertensive's life span, there must be other things in the system that give an additional rise in blood pressure. The other things are really quite complex systems. They include Björn Folkow's structural changes, which we of course also worked on quite a lot ourselves. They include things like these endothelial factors, like nitric oxide, that diminish, and other local factors that cause constriction. In the end, having triggered these other factors into operation, you gradually destroy a lot of the peripheral organs, including the kidney, the brain and the myocardium. So, in other words, what triggers hypertension is the nervous system, and what kills you is the periphery.
Tell me: the obesity story, how do you weave that in?
I think obesity is one of the really overdone things in the press. It doesn't really cause a huge rise in blood pressure, but it causes some very nasty complications. It gives you, in the end, type 2 diabetes. If you get diabetes plus hypertension, you get slightly different complications to the ones that I have just been talking about, but you get very serious diabetic complications added to hypertension, which is also a deadly mix. So it is the combination of diabetes plus hypertension that accounts for the adverse effects of obesity.
An interesting question about obesity is: how is it linked to hypertension? Long before obesity become fashionable, one of the things you couldn't help noticing is that, in any series of hypertension, the people were always, even the so-called lean hypertensives, up to two, three or five kilos heavier than the normal-tensive age-matched controls. What I think happens is that people, when they get stressed, start eating too much. In most people, the system that regulates energy balance keeps that in check and their weight doesn't really go up. But in about 40 per cent of people the cortex manages to ignore this, for reasons that are not well understood.
Mine certainly does!
Well, it does. You keep yourself in check now, thanks to your wife, Alexandra.
Where do the genes fit into all of this? You said that you had to do a lot on the molecular biological and genetic side of it.
There is absolutely no doubt that, roughly speaking, if you look at the blood pressure variation in the population, about 30 per cent is due to genetic factors and about 60 to 70 per cent to environmental factors, yet the genes are absolutely critical in the whole story. So the question really is: what do they do? Again, I wish I knew the answer to that. One possibility is: why are these neurones that sensitise the response to stress between the cortex and the hypothalamus, why are these synapses sensitisable? Normally, the autonomic nervous system can be conditioned to do things, but they don't even behave like memory neurones, where the stimulus can become smaller and smaller to elicit the response. So, possibly, it must be a developmental set of genes that do this. There may also be genes, in relation to what you mentioned about obesity, that allow you to ignore the messages from your energy balance. These are examples of these nonlinear systems that I was talking about earlier.
The other thing is salt. If you eat too much salt, according to the Guyton theory, blood pressure is meant to be going up through the kidney, and it will do that in people with renal impairment. But in people with normal kidneys, which most of the initial hypertensives are, it doesn't do that; it goes through the brain. The permeability of the blood-brain barrier to salt increases so that, in the end, the question is: what genetic factors are involved in making the blood-brain barrier leak here? Again, these are the sorts of things that are not known. One reason why I would have liked to have started this book earlier is that we could have probably found some of these things out by now.
Select activities that are most appropriate for your lesson plan or add your own. You can also encourage students to identify key issues in the preceding extract and devise their own questions or topics for discussion.
© 2025 Australian Academy of Science
