Case 34-1991

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Abstract
Presentation of CaseA 51-year-old man was admitted to the hospital because of severe hypertension and increasing renal failure.There was a five-year history of mild, labile hypertension that was treated for three months with hydrochlorothiazide—triamterene four years before admission; the patient did not tolerate the medication, and it was discontinued. Six months before entry, at a routine physical examination, the blood pressure was 210/120 mm Hg. The creatinine was 140 μmol per liter (1.6 mg per 100 ml). An x-ray film of the chest was said to be "clear." Enalapril was prescribed, but control of the hypertension became increasingly . . .