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Recent evidence suggests that immunogenic factors may be of importance for development and maintenance of severe hypertension. Twenty-three patients with a previously malignant phase of hypertension (MH) were investigated with respect to serum levels as well as actual production of immunoglobuiins (Igs) and compared with a group of 22 patients with non-malignant hypertension (NMH) and 45 matched normotensive control subjects (C). Patients with MH had a significantly elevated secretion of IgG and IgA as compared with C. Total serum concentration of Igs did not differ between the groups, but a raised level of the subclass IgG3 was found in MH. There was a significant positive correlation between systolic blood pressure (SBP) and secretion of IgA and IgG when all hypertensive patients were studied. Six patients were subjected to repeated investigations during the first year after malignant phase. If examined in an early phase of MH (within 4 months) the secretion of IgG, IgA and IgM was enhanced compared with later stages (after 5–12 months). The results suggest that an immunological process is involved in MH. This could either be a primary immunological disturbance or more plausibly secondary effects due to the vascular damage caused by the very high blood pressure.