DR. Royal J. Eaton, Senior Assistant Resident in Medicine, The Jewish Hospital of St. Louis and Assistant in Medicine, Washington University School of Medicine: A 40-year-old white man was admitted for evaluation of hypertension that had been diagnosed three years prior to admission during a routine life insurance physical examination. The patient was completely asymptomatic with the exception of occasional occipital headaches on arising in the morning. He had been treated at intervals with hydralazine and guanethidine in combination with chlorothiazide therapy, but had not received treatment during the two months prior to admission. There was a strong familial history of hypertension with blood pressure elevations present in the patient's father as well as in two of the patient's four siblings. Results of the physical examination were completely within normal limits except for a fixed hypertension (190/120 mm Hg), mild retinal arteriovenous nicking and a grade 2 systolic ejection murmur.