Blood pressure elevation of adequate severity and for a prolonged period of time will definitely produce vascular changes in the brain, the heart, and the kidneys. The more severe the hypertension, the more marked these changes will be in the kidneys. Effective reduction of blood pressure may completely arrest these vascular changes regardless of the method used for blood pressure reduction. Although the changes are arrested, renal function rarely returns to normal. Hypertension aggravates and hastens the development of arteriosclerosis. Reducing the blood pressure arrests this hastening process, but still arteriosclerosis progresses just as it does in the normotensive individual. The method of blood pressure reduction is probably not important, insofar as arresting the vascular changes associated with hypertension is concerned. The important thing is that the blood pressure be reduced effectively. This the surgeon can do, particularly when he employs concurrent medical therapy. We would concur with this approach just as long as the blood pressure is severe enough to warrant surgical therapy and the surgeon is proficient at doing sympathectomies. On the other hand, when the psychiatrist, or the general practitioner, or the internist who carries psychiatric overtones, can “talk the blood pressure down,” this is good therapy. Unfortunately, being neither psychiatrist nor surgeon, we prefer to use drugs and our results using psychotherapy (and placebo) have been poor. Any drug therapeutic program that is effective in bringing the blood pressure to a normal or relatively normal levels, is an effective therapeutic program. Generally speaking, our program has been one of polypharmacy in which we attempt to deplete body sodium with chlorothiazide. This drug is continued indefinitely as a background medication for all antihypertensive drugs. This is probably the most effective measure for blood pressure reduction. Then the sympathetic nervous system is blocked by different methods. The centrally acting drugs are used first. The most common ones are rauwolfia and hydralazine. Usually in milder cases rauwolfia is given an initial trial alone and if the patient needs additional therapy, he may receive hydralazine (Apresoline). In the moderatelysevere cases, we give a therapeutic trial of hydralazine with rauwolfia. For the more severe cases when the diastolic blood pressure is fixed above 120 to 130 mm Hg, we use ganglionic blocking agents, such as mecamylamine or pentolinium.