Accelerated or malignant hypertension is a progressive vasospastic disease characterized by rapidly increasing peripheral vascular resistance. Arterial pressure must be quickly and effectively reduced to halt arteriolar deterioration and to prevent advancing renal damage, hemorrhagic complications, or hypertensive encephalopathy. In most patients this decrease can be accomplished with a variety of antihypertensive drugs or drug combinations. Only a few cases of accelerated hypertension fail or cease to respond satisfactorily to the commonly employed agents. Such cases have been labeled "refractory" hypertension, and some have been treated with bilateral nephrectomies. Lack of adequate response to the usual antihypertensive drugs should not . . .