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A case of malignant hypertension.

A 44-year-old woman presented with a 3 day history of central visual field impairment in the left eye, which had not changed since onset. The only past medical history of note was that during both pregnancies she had been hypertensive, for which she had required hospital admission. She had not been investigated post-partum and was on no anti-hypertensive medication. On examination, she had a tachycardia of 112 per min with no radio-femoral delay, a blood pressure of 240/130 in both arms and a bruit audible over the left renal area. No abdominal mass was palpable. Fundoscopy showed a blot haemorrhage in the left retina, bilateral papilloedema with blurred disc margins and arteriovenous nipping. Urinalysis revealed proteinuria.