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October 1956

Intractable, Severe Hypertensive Disease: Observations on Resistance to Treatment with Current Drugs, Denervation of the Carotid Sinuses, Hypertensive Encephalopathy, and Other Complications

AMA Arch Intern Med. 1956;98(4):416-426. doi:10.1001/archinte.1956.00250280018004

Most current reports on antipressor drugs concern their effectiveness in groups of patients and give little consideration to cases in which drugs have been ineffective. Rather, the proportions that respond faably are listed and some exemplary responses may be summarized.

The present report contrasts with this custom. It deals primarily with one patient whose severe hypertensive disease was not controlled by available drugs. Relevant observations made in other patients are noted. The data bear on the effects and complications of antihypertensive drugs and on effects of carotid sinus denervation; they are concerned also with the nature of hypertensive encephalopathy and the mechanism of hexamethonium resistance and, in brief, with unusual renal and metabolic symptoms and signs noted in this patient.

Report of a Case  The patient was found to have high blood pressure at a physical examination in 1947. When first seen at the Cleveland Clinic in November, 1951, which

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