The prognosis of malignant hypertension without treatment is poor, with more than 80% mortality in two years. It is unusual to see it on more than one occasion in the same patient. We demonstrated clinical course, response to treatment and outcome of a patient presenting with recurrent malignant hypertension. In this patient, we did not see high renin as expected, but hypotensive effect of ARB and ACE inhibitor with normal salt diet was good. This is not surprising, since it has been shown that dual renin-aldosteron system blockade is more effective than doubling the usual dose of an ARB. Dual renin-angiotensin system blockade was effective in controlling blood pressure and restoring organ damage with regression of left ventricular hypertrophy and restoring renal function.
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