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Sir,Primary aldosteronism is one of the most common causes of secondary hypertension. However, it is rare for this disease to induce malignant hypertension associated with vascular organ damage including renal failure.1 One of the reasons for this is that, even in the malignant phase, renin activity and subsequent angiotensin II production remain suppressed in primary aldosteronism. Here, we report a case with aldosterone‐producing adenoma and increased renin activity complicated by malignant hypertension and renal failure, which required haemodialysis therapy. This case is noteworthy, because medical therapy with angiotensin‐converting enzyme (ACE) inhibitor effectively improved renal function, allowing discontinuation of dialysis.A 40‐year‐old woman consulted a physician on 2 January 2000, complaining of dyspnea, general fatigue, anorexia and headache. The patient appeared drowsy and her blood pressure was 260/140 mmHg. Serum creatinine was 7.1 mg/dl and severe pleural effusion was detected on chest X‐ray. Optic fundi exhibited papilloedema and haemorrhage (Keith‐Wagener's grade IV). She was admitted to hospital and treated with antihypertensive drugs and intermittent haemodialysis, which was needed three times a week thereafter. Blood pressure was managed by continuous intravenous infusion of nicardipine, which effectively lowered blood pressure to 170/80 mmHg. As renal function had not improved, the patient was transferred to our hospital …

Recovery from renal failure in malignant hypertension associated with primary aldosteronism: effect of an ACE inhibitor