Accelerated, or malignant, hypertension is a disorder whose natural history has been so greatly changed by the availability of effective diagnosis and therapy that many physicians no longer encounter it. In this issue of the Journal, Messerli recalls the progressive deterioration and death from untreated hypertension of President Franklin D. Roosevelt.1 Over a period of 10 years, Roosevelt progressed from having what is now termed “high-normal blood pressure” to having very severe (stage 4) hypertension complicated by left ventricular enlargement and proteinuria. He had untreated heart failure during the most critical period of World War II and died of an. © 1995, Massachusetts Medical Society. All rights reserved.