Dr. James J. Pollard: This was the first admission of a 33-yr-old married woman with high blood pressure, first noted 10 yr ago on a routine physical examination. Her only symptom has been frequent, severe, throbbing occipital headaches. She has had two uncomplicated pregnancies. She had one episode of burning and frequency 8 yr ago which cleared spontaneously. Her local physician recently heard a right flank bruit and referred her to the Massachusetts General Hospital.
Physical examination showed a well-developed, well-nourished female in no acute distress. Temperature, pulse, and respiration were normal. Her blood pressure was 180/110 mm Hg in the right arm and 200/120 mm Hg in the right leg. The fundi showed slightly tortuous arteries but no spasm, hemorrhage, or exudates. The left border of cardiac dullness was in the midclavicular line and the lungs were clear. There was a systolic bruit heard over the right side of