Lip G Y, Beevers M, Beevers D G
University Department of Medicine, City Hospital, Birmingham, England.
Am J Hypertens. 2000 Aug;13(8):934-9. doi: 10.1016/s0895-7061(99)00283-6.
Malignant phase hypertension (MHT) represents the most severe form of hypertension, and many consider that this condition only occurs in poorly managed patients with previously known hypertension. To investigate this further, we studied 350 patients with MHT on the West Birmingham MHT database: 195 (55.7%) of these presented de novo, without any known past history of hypertension (Group 1), and 146 (41.7%) were previously known hypertensives (Group 2), of whom 86 were receiving antihypertensive therapy; in 9 patients, the status was uncertain. Median duration of clinical followup was similar in both groups (36.0 v 37.5 months, Mann-Whitney test P = .795). Patients presenting de novo with MHT (Group 1) were younger, with a predominance of whites and men. Nevertheless, the clinical features, blood pressures, and renal function at presentation were similar to MHT patients with previously known hypertension. Renal function at follow-up was also similar in both groups. There was an excess of women and nonwhites in MHT patients with previously known hypertension (Group 2), who also had higher mean follow-up blood pressures. On univariate life-table analysis, there was no statistically significant difference in survival time between Groups 1 and 2 (mean 57.5 v 63.5 months, median 36.0 v 37.0 months; log-rank test, P = .456). Using a multivariate Cox analysis of baseline variables, the independent predictors of outcome (death or dialysis) were age at presentation (P = .0019), diastolic blood pressure (P = .0466), serum urea (P = .006), and serum creatinine (P < .001). Whether the patient had presented de novo, without any known history of hypertension (Group 1) or had previously known hypertension (Group 2) did not independently predict outcome (P = .6549). We suggest that MHT can occur de novo in patients without previously known hypertension, and the clinical characteristics and prognosis in such patients were similar to MHT patients with previously known hypertension.
恶性期高血压（MHT）是高血压最严重的形式，许多人认为这种情况仅发生在高血压管理不善的已知高血压患者中。为进一步研究这一情况，我们对西米德兰兹郡MHT数据库中的350例MHT患者进行了研究：其中195例（55.7%）为新发患者，既往无高血压病史（第1组），146例（41.7%）为已知高血压患者（第2组），其中86例正在接受抗高血压治疗；9例患者的情况不明。两组的临床随访中位持续时间相似（36.0对37.5个月，Mann-Whitney检验P = 0.795）。新发MHT患者（第1组）较年轻，以白人和男性为主。然而，就诊时的临床特征、血压和肾功能与已知高血压的MHT患者相似。随访时两组的肾功能也相似。已知高血压的MHT患者（第2组）中女性和非白人较多，其平均随访血压也较高。单变量生命表分析显示，第1组和第2组的生存时间无统计学显著差异（平均57.5对63.5个月，中位36.0对37.0个月；对数秩检验，P = 0.456）。使用多变量Cox分析基线变量，结局（死亡或透析）的独立预测因素为就诊时年龄（P = 0.0019）、舒张压（P = 0.0466）、血清尿素（P = 0.006）和血清肌酐（P < 0.001）。患者是新发且无高血压病史（第1组）还是已知高血压（第2组）并不能独立预测结局（P = 0.6549）。我们认为，MHT可在无既往高血压病史的患者中新发，此类患者的临床特征和预后与已知高血压的MHT患者相似。
