Shantsila Alena, Shantsila Eduard, Beevers D Gareth, Lip Gregory Y H
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
J Hypertens. 2017 Nov;35(11):2310-2314. doi: 10.1097/HJH.0000000000001446.
Malignant hypertension represents a high-risk condition and there are scarce data on current clinical patterns of this condition. The aim of the study is to identify the clinical and demographic factors associated with poor outcome.
The data collected from 1958 to May 2016 included a total of 351 patients whose 5-year survival status was known: 221 white Caucasians (63%, age 51 ± 13 years, 64% male), 83 African-Caribbeans (24%, 45 ± 11 years, 61% male), and 47 South Asians (13%, 42 ± 11 years, 74% male).
During the 5-year follow-up 119 (34%) patients suffered a primary outcome, defined as the composite endpoint of death or dialysis. The 5-year mortality ranged from 76% in patients diagnosed before 1967 to 7% in patients diagnosed between 1997 and 2006. The independent predictors of outcome were advanced age (vs. a reference group of < 40-year-old; P = 0.01 for age at presentation 51-60 years, P < 0.001 for age > 60 years), prior use of antihypertensive medications (P = 0.002), higher serum creatinine (P = 0.006), and proteinuria (P < 0.01). Also, white Caucasian (odds ratio12.02, 95% confidence interval 1.64-88.15, P = 0.01) and African-Caribbean (odds ratio 15.55, 95% confidence interval 2.06-117.29, P = 0.008) origins were associated with higher mortality vs. South Asians. The years of the diagnosis after 1977 were significantly associated with lower composite endpoint of death or dialysis, all P < 0.01.
There has been a major improvement in 5-year survival in patients with malignant hypertension over recent decades. Abnormal renal function at presentation still predicts worse outcome. South Asian ethnicity is also associated with better outcome, although mechanisms involved are yet to be established.
恶性高血压是一种高危疾病，目前关于该疾病临床模式的数据稀缺。本研究的目的是确定与不良预后相关的临床和人口统计学因素。
收集1958年至2016年5月的数据，共纳入351例已知5年生存状态的患者：221例白种人（63%，年龄51±13岁，64%为男性），83例非洲裔加勒比人（24%，45±11岁，61%为男性），47例南亚人（13%，42±11岁，74%为男性）。
在5年随访期间，119例（34%）患者出现主要结局，定义为死亡或透析的复合终点。5年死亡率从1967年前诊断的患者中的76%到1997年至2006年诊断的患者中的7%不等。结局的独立预测因素为高龄（与<40岁的参照组相比；就诊时年龄51 - 60岁，P = 0.01；年龄>60岁，P < 0.001）、既往使用抗高血压药物（P = 0.002）、较高的血清肌酐水平（P = 0.006）和蛋白尿（P < 0.01）。此外，与南亚人相比，白种人（比值比12.02，95%置信区间1.64 - 88.15，P = 0.01）和非洲裔加勒比人（比值比15.55，95%置信区间2.06 - 117.29，P = 0.008）的死亡率更高。1977年后诊断的年份与死亡或透析的复合终点显著降低相关，所有P < 0.01。
近几十年来，恶性高血压患者的5年生存率有了显著提高。就诊时肾功能异常仍预示着更差的结局。南亚种族也与较好的结局相关，尽管其中涉及的机制尚待确定。
