THE MANAGEMENT OF MALIGNANT HYPERTENSION

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Abstract
Patients with malignant hypertension who are given only supportive treatment rarely survive longer than a year. With newer methods of therapy, reversal of papilledema, significant clinical improvement, and increase survival may be expected in approx. half of the patients with this disease, provided renal function is satisfactory. Modern methods of treatment include the use of hexamethonium sub-cut. or orally, 1-hydrazinophthalazine alone or in conjunction with hexamethonium, the purified Veratrum compounds, or repeated pyrogen therapy. Thoracolumbar sympathectomy appears to be the most successful surgical procedure; bilateral adrenalectomy remains to be evaluated. Restriction of sodium, and psychotherapy are useful as adjuncts to either drug or surgical therapy. Once surgically correctable lesions have been excluded in patients with hypertension and papilledema, vigorous therapy under close medical supervision should be instituted with the newer drugs or with sympathectomy.