MALIGNANT HYPERTENSION, HYDRALAZINE TOXICITY, AND CARCINOMA

Syndromes which closely simulate disseminated lupus erythematosus and rheumatoid arthritis have been observed repeatedly in a minority of hypertensive patients treated with hydralazine hydrochloride. These interesting drug reactions usually occur after the blood pressure has returned to normal levels. It is not known whether the syndromes are induced de novo by the drug, or whether pre-existing latent forms of these diseases are "uncovered" by administration of hydralazine. With cessation of therapy, the manifestations disappear, but antinuclear globulins may persist in the plasma for periods known to be as long as 5 years. In this issue of The Journal (p 1020), Perry reports that, among 24 patients with malignant hypertension in whom the lupus erythematosus or rheumatoid arthritis reaction developed while being treated with hydralazine, carcinoma occurred in four, three of whom were less than 50 years of age. This apparently high incidence was all the more interesting because it was