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Long-term prognosis in malignant or accelerated hypertension
C Guerin1, R Gonthier, F C Berthoux
1Faculté de Médecine, Hôpital Nord, Saint-Priest-en-Jarez, France.
Insights
Malignant hypertension significantly impacts survival, with 70% of patients experiencing renal death or requiring dialysis within the study period. Blood pressure control benefits heart and brain health but not kidney outcomes in these high-risk patients.
Area of Science:
- Nephrology
- Cardiology
- Neurology
Background:
- Malignant hypertension is a severe form of hypertension.
- Early diagnosis and management are crucial for patient outcomes.
Purpose of the Study:
- To analyze patient and kidney survival rates in patients with malignant hypertension.
- To identify risk factors for mortality and renal failure.
Main Methods:
- Retrospective analysis of 51 consecutive patients with malignant hypertension.
- Data collected between 1976 and 1981.
- Assessment of patient and kidney survival at 5-year and last follow-up.
Main Results:
- At 5 years, patient survival was 72.5% and kidney survival was 47%.
- At last follow-up, 35% of patients died and 35% required dialysis (70% renal death).
- Higher risk identified in patients with serum creatinine > 200 µmol/l on admission.
Conclusions:
- Malignant hypertension is associated with poor long-term patient and kidney survival.
- Blood pressure control improves cardiovascular and cerebrovascular outcomes but not renal outcomes.
- Serum creatinine levels on admission are a key predictor of risk.
Abstract:
In 51 consecutive patients with malignant hypertension collected from 1976 to 1981 we have analysed patient and kidney survival at 5 years and at last follow-up. The patients were 41 men, 10 women, mean age 53 years, with a stage III (63%) or stage IV (27%) fundi and a diastolic blood pressure (BP) greater than 130 mmHg. The hypertension was primary in 26, renovascular in 17 and secondary to bilateral nephropathy in eight. At 5-years follow-up, the patient and kidney survival rates were respectively 72.5% and 47%. At last follow-up, 18 patients had died (35%) and 18 additional patients require dialysis (renal death = 70%). The principal causes of death related to terminal renal failure and/or dialysis. Initial involvement of heart (27%) and brain (35%) led to a few more deaths. Blood pressure control reduced consequences for the heart and brain but not for the kidney. Patients at higher risk are those with serum creatinine greater than 200 mumol/l on admission.