The short-term course of renal function in malignant hypertensives with renal insufficiency

Vigorous antihypertensive therapy in patients with malignant hypertension and renal insufficiency was evaluated to (a) predict which patients would show short-term improvement in renal function and which would require dialysis and (b) establish a time-frame for the improvement. Twenty-one patients were discharged at 32 +/- 4 days with improved or stable renal function (compared to admission) and another 21 patients had worse renal function at 42 +/- 7 days. Admission blood pressure and blood pressure control were the same in the two groups. If admission serum creatinine (Scr) was 1.4-4.4 mg/dl, 68% of the patients were discharged with stable or improved Scr and dialysis was not required. If Scr was 4.5-6.9 mg/dl, 1/4 required dialysis; if 7-9.9 mg/dl, 1/2 required dialysis; if greater than 10 mg/dl, 3/4 required dialysis. Seven of 8 patients admitted with congestive heart failure required dialysis. In 10% of patients (n = 5) renal function immediately stabilized. In 30% (n - 13) renal function progressively deteriorated. In 60% (n = 24) renal function transiently deteriorated and then improved. In 22 of the 24, Scr peaked by 2 weeks and then declined. Malignant hypertensives with renal insufficiency who will potentially show improvement in renal function can be identified after two weeks of vigorous antihypertensive therapy. Four of the total group (n = 42) died during hospitalization and an additional 9 patients died by 1 year follow-up. The overall 1 year survival was 69%.