A 63-year-old white man was referred for evaluation of hypertension. He had an elevated BP for approximately 10 years. Medications had been administered for approximately 7 years, but during the past 2 years, his BP had become more difficult to control, requiring increasing doses of metoprolol and lisinopril. Home monitoring of BP generally yielded values ranging from 150 to 180 mm Hg systolic and > 80 to 100 mm Hg diastolic. At the time of his most recent office visit, he was asymptomatic. His medical history disclosed that, other than hypertension, he had sustained a myocardial infarction 3 years previously with no subsequent complications. At the time, he was treated in an outlying hospital with tissue plasminogen activator. During that period, he had mild hypercholesterolemia and was administered simvastatin for its control. He had been a cigarette smoker, one to two packs per day, for 40 years until he stopped at the time of his cardiac event. Alcohol consumption was estimated at no more than one ounce daily. He also had occasional episodes of dyspepsia for which he was treated with antacids. There was no evidence of angina pectoris, and he denied the presence of significant dyspnea. Regarding the family history, his father and one of three brothers had been hypertensive. The father had died of an acute myocardial infarction at the age of 58 years. His mother was living and well at the age of 84 years. Current medications consisted of lisinopril, 40 mg/d; hydrochlorothiazide, 12.5 mg/d; metoprolol, 100 mg bid; simvastatin, 40 mg/d; and enteric coated aspirin, 325 mg/d.