The hypornatremic hypertensive syndrome is a rare and less recognized syndrome. The syndrome is characterized by hypertension and profound natriuriesis leading to sodium and water depletion. Hypertension is refractory to treatment. We report a 45 year old male with this syndrome with hyponatremia and confirmed renal artery stenosis. Syndrome should be suspected in patients in whom severe hypertension is associated with hyponaterima  without apparent cause.