van den Born Bert-Jan H, Koopmans Richard P, Groeneveld Johan O, van Montfrans Gert A
Department of Internal and Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
J Hypertens. 2006 Nov;24(11):2299-304. doi: 10.1097/01.hjh.0000249710.21146.38.
The incidence of malignant hypertension has declined after the introduction of antihypertensive agents. However, previous reports have suggested that malignant hypertension may be relatively common in multi-ethnic populations. The aim of this study was to compare ethnic disparities in the incidence, clinical characteristics and complications of malignant hypertension.
A retrospective cohort study on malignant hypertension in a multi-ethnic population in Amsterdam, the Netherlands, between August 1993 and August 2005.
A total of 122 patients with malignant hypertension were included, mean age 44 years (+/- 12), 66% were men and 47% were black. The incidence rate remained approximately 2.6 (+/- 0.9) per 100,000 per year and was higher among blacks. Black individuals had higher systolic blood pressure (234 +/- 23 versus 225 +/- 22, P = 0.03) and more renal dysfunction compared with white individuals (39% with serum creatinine > 300 micromol/l versus 22%, P = 0.04). Hypertension was previously diagnosed in 58% of all patients, 37% received medication, and 23% stopped their drugs before admission. Health insurance was absent in 25% of black and 2% of white patients (P < 0.01). Secondary causes were identified in 40% of white and 10% of black subjects (P < 0.01). After a mean follow-up of 4.0 +/- 3.2 years 10% had died and 19% needed renal replacement therapy. Renal failure was more frequent in black than in white individuals (hazard ratio 2.8; 95% confidence interval 1.1-7.2), but mainly because of higher serum creatinine levels at presentation.
The incidence of malignant hypertension and related renal complications is higher in black compared with white individuals. These differences may be explained by ethnic disparities in blood pressure control, drug adherence and insurance status.
抗高血压药物问世后，恶性高血压的发病率有所下降。然而，既往报告提示，恶性高血压在多民族人群中可能相对常见。本研究旨在比较恶性高血压在发病率、临床特征及并发症方面的种族差异。
对1993年8月至2005年8月期间荷兰阿姆斯特丹多民族人群中的恶性高血压进行一项回顾性队列研究。
共纳入122例恶性高血压患者，平均年龄44岁（±12岁），66%为男性，47%为黑人。发病率约为每年每10万人2.6例（±0.9例），黑人中的发病率更高。与白人相比，黑人的收缩压更高（234±23 vs 225±22，P = 0.03），肾功能不全更多见（血清肌酐>300 μmol/L者占39% vs 22%，P = 0.04）。所有患者中，58%既往诊断过高血压，37%接受过药物治疗，23%在入院前停药。25%的黑人患者和2%的白人患者没有健康保险（P < 0.01）。40%的白人患者和10%的黑人患者发现有继发性病因（P < 0.01）。平均随访4.0±3.2年后，10%的患者死亡，19%的患者需要肾脏替代治疗。黑人发生肾衰竭的频率高于白人（风险比2.8；95%置信区间1.1 - 7.2），但主要是因为就诊时血清肌酐水平较高。
与白人相比，黑人中恶性高血压及相关肾脏并发症的发病率更高。这些差异可能由血压控制、药物依从性及保险状况方面的种族差异所解释。
