Created by Mark Rein-Hagen and published by White Wolf in 1991, it sets its world in the modern city we already live in, with vampire politics running underneath. Players take the monster’s side rather than the hunter’s: you inherit a Clan’s Disciplines and survive between the Camarilla’s laws and the hunters, keeping what you are concealed.
Hunger sits at the centre of the rules. As blood runs low the Beast comes forward, and what it does then cannot be taken back. The current fifth edition surfaces that struggle as a Hunger track, so each scene counts how much of yourself is left.
What the game changed is the direction of fear — not the thing coming at you from outside, but the thing growing inside you. Most horror RPGs since begin from that position.