Lip G Y, Beevers M, Beevers D G
University Department of Medicine, City Hospital, Birmingham, UK.
J Hypertens. 1995 Aug;13(8):915-24. doi: 10.1097/00004872-199508000-00013.
To investigate the factors affecting survival in patients with malignant hypertension by analysing the prognosis of all of the patients referred to the City Hospital, Birmingham, with malignant hypertension since 1965.
We identified 315 patients with malignant hypertension (211 men, 104 women; mean age +/- SD 49.4 +/- 12.7 years). Of those patients, 219 were Caucasian, 55 were black and 41 were Asian. Black patients had greater renal impairment and higher blood pressures at presentation. After a median follow-up period of 33 months (range 1-389), 126 patients (40.0%) were still alive, 126 patients (40.0%) were dead, 10 patients (3.2%) were receiving chronic haemodialysis and 53 patients (16.8%) were lost to follow-up. Mean follow-up blood pressures in the patients who died were significantly higher than in those who lived. Median survival times for Caucasian, black and Asian patients were 121.0, 30.4 and 107.5 months, respectively, with the lowest survival time being that of black patients. There was a lower median survival time among patients with proteinuria and high serum urea (> 10 mmol/l) and creatinine (> 200 mumol/l) levels at presentation and if left ventricular hypertrophy was detected on the electrocardiogram, but there was no difference in median survival time between those with and without haematuria, nor between non-smokers and current or former smokers. The most common causes of death were renal failure (39.7%), stroke (23.8%), myocardial infarction (11.1%) and heart failure (10.3%). Median survival times for the patients who presented before 1970, during 1970-1979 and during 1980-1989 were 39.2, 68.6 and 144.0+ months, respectively, demonstrating an improved survival time for the patients who were diagnosed after 1980. Using multivariate Cox's proportional hazards analyses, the duration of known hypertension and serum urea level at presentation were found to be the main predictors of survival.
Malignant hypertension remains a disease with a poor overall prognosis, namely progression to death or chronic renal haemodialysis. The prognosis has improved with recent advances in therapy, with a 5-year survival of 74% of patients. The poor outlook for black patients could be explained by their late presentation with severe hypertension and the higher prevalence of renal impairment in this group.
通过分析自1965年以来转诊至伯明翰城市医院的所有恶性高血压患者的预后情况，研究影响恶性高血压患者生存的因素。
我们确定了315例恶性高血压患者（211例男性，104例女性；平均年龄±标准差49.4±12.7岁）。其中，219例为白种人，55例为黑人，41例为亚洲人。黑人患者就诊时肾功能损害更严重，血压更高。中位随访期为33个月（范围1 - 389个月），126例患者（40.0%）仍存活，126例患者（40.0%）死亡，10例患者（3.2%）接受慢性血液透析，53例患者（16.8%）失访。死亡患者的平均随访血压显著高于存活患者。白种人、黑人和亚洲患者的中位生存时间分别为121.0、30.4和107.5个月，其中黑人患者的生存时间最短。就诊时出现蛋白尿、血清尿素（>10 mmol/L）和肌酐（>200 μmol/L）水平升高以及心电图检测到左心室肥厚的患者中位生存时间较短，但有无血尿患者之间以及非吸烟者与当前或既往吸烟者之间的中位生存时间无差异。最常见的死亡原因是肾衰竭（39.7%）、中风（23.8%）、心肌梗死（11.1%）和心力衰竭（10.3%）。1970年前、1970 - 1979年期间和1980 - 1989年期间就诊的患者中位生存时间分别为39.2、68.6和144.0 +个月，表明1980年后诊断的患者生存时间有所改善。使用多变量Cox比例风险分析发现，已知高血压的持续时间和就诊时的血清尿素水平是生存的主要预测因素。
恶性高血压总体预后仍然较差，即进展至死亡或慢性肾透析。随着近期治疗进展，预后有所改善，患者5年生存率为74%。黑人患者预后较差的原因可能是他们出现严重高血压较晚且该组肾功能损害患病率较高。
