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Accelerated (malignant) hypertension: a study of 121 cases between 1974 and 1996
P T Scarpelli1, R Livi, G M Caselli
1Postgraduate School of Nephrology, Institute of Clinical Medicine IV, University of Florence, Italy.
Insights
Effective pharmacological treatment for accelerated hypertension significantly preserves renal function and improves survival rates. Early intervention and sustained blood pressure control are key to long-term patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Accelerated hypertension presents a significant clinical challenge with potential for severe organ damage.
- Understanding the long-term effects of treatment is crucial for managing this condition.
Purpose of the Study:
- To analyze the impact of pharmacological treatment on blood pressure and disease course in patients with accelerated essential hypertension.
- To evaluate the long-term preservation of renal function and survival rates in relation to treatment efficacy.
Main Methods:
- Retrospective analysis of 121 consecutive cases of accelerated hypertension.
- Focus on 47 patients with essential hypertension, excluding secondary causes.
- Blood pressure (BP) monitoring through daily self-measurements; plasma creatinine levels assessed over time.
Main Results:
- Introduction of new hypotensive drugs in the 1980s correlated with decreased plasma creatinine levels.
- Sustained BP reduction preserved renal function, especially when initial creatinine levels were ≤ 2 mg/dl.
- Patients treated after 1980 demonstrated a 100% 12-year survival rate, compared to 69% for the entire cohort.
Conclusions:
- Pharmacological management of accelerated hypertension can lead to sustained blood pressure control and long-term renal function preservation.
- Improved treatment strategies, particularly after 1980, have dramatically enhanced survival rates in these patients.
- Early and effective blood pressure management is critical for improving outcomes in accelerated hypertension.
Abstract:
A series of 121 consecutive cases with accelerated hypertension is presented. Forty-seven patients had essential hypertension. This diagnosis was confirmed during the follow-up, which lasted from 3 to 255 months (mean 63.1 +/- 58.1). The relationship between the effects of pharmacological treatment on high blood pressure (BP) and disease course were analyzed in accelerated essential hypertensive patients only, to avoid the imponderable influence of basic disease in secondary hypertension. In most cases, therapeutical effect on BP was monitored by multiple daily BP self-measurements. Since 1974, when this study was initiated, plasma creatinine concentration at admission showed a clear-cut decrease, especially after the introduction in the eighties of new hypotensive drugs. A sustained BP decrease assured a long-lasting preservation of renal function, if the initial functional loss was limited (plasma creatinine concentration of 2 mg/dl (176.8 mumol/l) or less). Renal function was preserved even if the BP decrease was not optimal and signs of relapsing malignant retinopathy were observed in the course of disease. Although the whole series showed a 12-year survival rate of about 69%, patients enrolled after 1980 had a 100% survival rate.