Bulpitt C J, Bulpitt P F, Clark P B, Crombie D L, Lambert P, Dollery C T
J R Coll Gen Pract. 1985 Oct;35(279):471-5.
A diagnosis of malignant hypertension was recorded for 165 patients in the national morbidity study between 1970 and 1973. Three patients with benign hypertension were selected as age- and sex-matched controls for each case. The general practitioners in the study were asked to complete a further questionnaire about the patients and 66% of the practices agreed to take part. Information about the retinal findings for the patients was requested and less than half of those in the national morbidity study proved to have a strict diagnosis of accelerated or malignant hypertension although they were originally recorded as patients with malignant hypertension. Of those patients originally classified as having benign hypertension 5% had the retinal appearance of accelerated or malignant hypertension.Patients had been diagnosed as having hypertension for a mean of more than five years prior to entry into the national morbidity study and the survival of patients with both benign and accelerated or malignant hypertension was good. Thirtyfour per cent of those with confirmed benign hypertension and 62% of those with definite accelerated or malignant hypertension died in the follow-up period which was on average 10 years from entry into the national morbidity study.The survival of patients registered with doctors who did not collaborate and of patients whose clinical details were missing was similar to the survival of patients for whom full details were provided.Blood pressure control was only fair with a mean of 172/101 mmHg for the group with benign hypertension and 177/107 mmHg for the group with accelerated or malignant hypertension. Blood pressure control was the poorest for those who died from a stroke. A high proportion (78%) of deaths in association with accelerated or malignant hypertension were from cardiovascular or renal causes.
在1970年至1973年的全国发病率研究中，记录了165例恶性高血压患者的诊断情况。为每例患者选取3例年龄和性别匹配的良性高血压患者作为对照。研究中的全科医生被要求填写一份关于患者的进一步问卷，66%的医疗机构同意参与。研究人员索要了患者的视网膜检查结果，结果发现，尽管最初被记录为恶性高血压患者，但在全国发病率研究中，不到一半的患者被严格诊断为急进性或恶性高血压。在最初被归类为良性高血压的患者中，5%有急进性或恶性高血压的视网膜表现。在进入全国发病率研究之前，患者被诊断为高血压的平均时间超过5年，良性高血压以及急进性或恶性高血压患者的生存率都较好。在随访期（平均从进入全国发病率研究起10年），确诊为良性高血压的患者中有34%死亡，确诊为急进性或恶性高血压的患者中有62%死亡。未参与合作的医生所登记患者以及临床细节缺失患者的生存率与提供了完整细节患者的生存率相似。血压控制情况一般，良性高血压组的平均血压为172/101 mmHg，急进性或恶性高血压组为177/107 mmHg。因中风死亡的患者血压控制最差。与急进性或恶性高血压相关的死亡中，很大一部分（78%）是由心血管或肾脏原因导致的。
