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November 1964

Adrenalectomy and Sympathectomy for Hypertension: Ten Year Survival

Author Affiliations

University of Pennsylvania School of Medicine, Assistant Professor of Medicine (Dr. Sellers); Fellow in Cardiology (Drs. Barrett and Lopez); Emeritus Professor of Medicine (Dr. Wolferth); and Associate in Medicine (Dr. Itskovitz); Graduate School of Medicine, Professor of Surgery (Dr. Blakemore); Columbia University College of Physicians and Surgeons, Clinical Professor of Surgery (Dr. Zintel).; From the Hypertension Section, Edward B. Robinette Foundation, Medical Department, and the Surgical Service of the Hospital of the University of Pennsylvania, Philadelphia. This investigation has been supported in part by research grants from the National Heart Institute, United States Public Health Service (H-338); the Heart Association of Southeastern Pennsylvania, and the Huffnagle Fund for Hypertension Research.

Arch Surg. 1964;89(5):880-886. doi:10.1001/archsurg.1964.01320050126011

Combined adrenalectomy and sympathectomy was performed in 171 patients with severe, intractable hypertension between the years of 1950 and 1959, at a time when the available antihypertensive therapy was often ineffective (Table 1).1-3 The advent of newer, more effective antihypertensive agents, primarily the thiazide diuretics and guanethidine, made this surgical treatment of hypertension unnecessary in our hands since 1959. However, the excellent long-term survival of these patients with advanced vascular disease has prompted publication of these results and reevaluation of its possible usefulness in certain specific instances.

Selection of patients for operation depended upon their failure to respond to medical therapy, diastolic pressure over 120 mm Hg and evidence of progressive vascular damage to the target organs of hypertension (Table 2). The Smithwick Classification was used as a basis for grading the severity of the hypertensive vascular disease in these patients.4 Sixty-eight patients (40%) were in Smithwick group 4

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