Development of hypertensive manifestations after the disappearance of hypertension.

The accelerated ("malignant") phase of hypertensive vascular disease is more common in men; sympathectomy may modify some of its signs and symptoms even in those cases in which hyper-tension is not modified. Six instances are reported herewith in which patients in the accelerated phase have developed retinopathy and papilledema during a sustained period of normal blood pressure brought on by a vascular accident or sympathectomy. Therefore factors other than the intensity of the hypertension may be involved in the pathogenesis of this phase. IN HYPERTENSIVE patients, events such as myocardial infarction, cerebral vascu-lar accidents or bilateral thoracolumbar sympathectomy may be followed by periods of normal blood pressure for weeks or even months. During such a period of reduced blood pressure, occlusive phenomena, changes in heart size, or alterations in renal function may occur, yet the underlying mechanisms cannot be interpreted with certainty; they may result from the pre-existing organic disease or be the sequel to a drop in arterial tension or to differences in cardiac function. On the other hand, progression of retinal lesions during this period of sustained normal blood pressure may throw some light on the processes involved-at least on those pertaining to the production of retinopathy. In six instances (three after a myocardial infarction, one after a cerebral thrombosis, two after sympathectomy) papilledema and retinopathy have been observed to appear during a normotensive period when they had been absent prior to the hypertensive phase.