Hypertension and retinal vascular insufficiency associated with platelet microthrombi.

A 45-year-old housewife entered the hospital because of abdominal pain and increasingly severe hypertension moderately well controlled by methyldopa. Both complaints had been present for only two years. The patient stated that for many months a dull epigastric pain frequently occurred after meals. The pain was aggravated by eating, but vomiting eased it. She had lost 10 kg of weight in the preceding four months. She also complained of tiredness, depression, occipital headaches, dysmenorrhea, dizziness, and seeing black spots before her eyes. No history was obtained of renal injury, pre-eclamptic toxemia, urinary tract infection, familial hypertension, or of recent or past loin pain. Except for the last two years, she had enjoyed good health. On examination the patient was moderately built (55 kg; 155 cm), febrile (37.2°C), and pale. Radial pulse was regular at 90 and the blood pressure was 230/130 mm Hg. The optic fundus showed irregularity of arterial caliber. Slight epigastric tenderness was present. An electrocardiogram showed left ventricular hypertrophy. A chest radiograph showed moderate enlargement of the heart, particularly the left ventricle. The descending aorta was moderately prominent. Increased density of the pulmonary vessels was noticeable in the hila of both lungs. Fast sequen-