To the Editor.—
A 65-year-old man with chronic stable angina was admitted to the hospital with hypertension of ten years' duration and right frontotemporal headaches of seven months' duration. An ECG showed left ventricular hypertrophy and an old anterior wall infarction. The BUN level was 28 mg/dl and the creatinine level was 1.4 mg/dl. Abdominal aortogram showed abundant clot in an abdominal aortic aneurysm and 99% stenosis at the origin of both renal arteries, which came off the aorta above the aneurysm.While receiving propranolol hydrochloride, 620 mg/day, methyldopa, 1 g/day, and a combination of spironolactone and hydrochlorothiazide (Aldactazide), two tablets twice a day, his blood pressure (BP) remained at 200/120 mm Hg. One week after admission, the patient showed depression of mental acuity, slurring of speech, and diplopia. Arteriography showed no conspicuous extracranial lesions; brain scan and computerized axial tomographic scan of the brain were normal. Progressive hypertensive encephalopathy
Farrell B, Bredenberg CE. Emergency Bilateral Renal Artery Reconstruction. JAMA. 1978;240(16):1716. doi:10.1001/jama.1978.03290160034014
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