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