Hypertension secondary to renal artery occlusive disease.

THE PROLONGED disability and shortened life span of patients with hypertension, as well as the expense and inconvenience of lifelong drug therapy, emphasize the urgent need for detecting curable forms of hypertension. The concept of an intimate causal relationship between hypertension and renal disease has developed slowly over the past 125 years. Bright, in 1836, noted the association of cardiac enlargement and chronic renal disease,' while Mahomed postulated in 1881 that high arterial pressure was a cause of Bright's disease.2 The first to report the onset of hypertension in a patient with unilateral pyelonephritis resulting from a ureteral stricture and the disappearance of the hypertension after nephrectomy was Crabtree (1927) .3 After Ask-Upmark's detailed description of six cases of juvenile malignant hypertension in which congenital unilateral renal abnormalities were found at autopsy (1929),4 Butler recorded in 1937 for the first time the successful treatment of hypertension by nephrectomy in a child with unilateral pyelonephritis.5 A similar but unreported case was observed by Kerr in 1936.6 In the same period of time Goldblatt and his co-workers (1934) investigated extensively the experimental production and mechanism of hypertension in animals in which the renal arteries had been ligated,7 and several authors subsequently amplified the studies of the causal relationship between renal ischemia and hypertension.8-'2