Therapy of severe hypertension complicated by renal failure

Abstract

During the last decade we have observed a decrease in ocular manifestations and an increase in renal failure as the presenting complaint of severely hypertensive but inadequately treated patients. During the period from 1950 to 1952 more than four times as many patients had the ocular changes of malignant hypertension without azotemia as had azotemia without ocular changes. During 1958 to 1960, the latter combination of findings had become nearly four times as frequent as the former. Despite the grim prognosis associated with renal failure in severely hypertensive patients, approximately a tenth of those with moderate, and a third of those with mild azotemia survived for three years. Brief follow-up notes on three previously reported patients illustrate the occasional striking benefits of lowering markedly elevated diastolic pressures, even in the presence of renal failure. Finally, the benefits of therapy are reemphasized by a more complete report of a young malignant hypertensive white woman with moderate azotemia who has done well for a seven year-period which included a full-term pregnancy.