Carcinoma and Hydralazine Toxicity in Patients with Malignant Hypertension

WITHOUT TREATMENT, the malignant (accelerated) phase of hypertension is a rapidly progressive disease with a predictably fatal outcome; the median survival time is four to six months after the diagnosis has been made.^1,2 Therapy has altered the prognosis for many of our patients, as demonstrated by a mean survival time of 25 months.³ Among those with the most severely compromised kidneys, however, the overall therapeutic results have remained poor. Some patients had little response to therapy and quickly succumbed to renal failure;³ others seemed unusually susceptible to toxic manifestations of various drugs, including hydralazine hydrochloride, hexamethonium chloride, and mecamylamine hydrochloride.⁴ Hydralazine toxicity was particularly disturbing because it involved those who had initially achieved good control of their diastolic pressures. Moreover, we have recently had cause to speculate that the same malignant hypertensive patients who were susceptible to hydralazine toxicity were also susceptible to neoplastic disease. Before presenting