Medical management that employs diet, rest, drugs, and psychotherapy has proved to be quite satisfactory in the treatment of essential hypertension without organic changes. Sympathectomy has been extensively used when minimal organic changes appear. It has ameliorated symptoms but lowered the pressures to normal in a varying low percentage of the patients operated on, regardless of the extent of resection. It is attended with stage procedures and, even in the best hands, morbidity and mortality. This operation obviously leaves much to be desired. If it is used in the presence of extensive organic changes, morbidity and mortality rise in proportion to the magnitude of the organic changes. Consequently, operative treatment is sought for the group of patients in whom medical therapy has failed, sympathectomy has failed, or the organic changes are so extensive that sympathectomy cannot be safely considered. A considerable number of these patients are seen at Kennedy Hospital.
Bowers RF. BILATERAL ADRENALECTOMY FOR SEVERE HYPERTENSION. JAMA. 1954;154(5):394-397. doi:10.1001/jama.1954.02940390018005