Mortality and Cardiovascular Risk in Patients With a History of Malignant Hypertension: A Case‐Control Study

Abstract

The survival of patients with malignant hypertension (MHT) has considerably improved over the past decades. Data regarding the excess risk of mortality and the contribution of conventional cardiovascular risk factors are lacking. The authors retrospectively assessed cardiovascular risk factors and all-cause mortality in 120 patients with a history of MHT and compared them with 120 normotensive and 120 hypertensive age-, sex-, and ethnicity-matched controls. Total cholesterol, low-density lipoprotein cholesterol, and body mass index were lower in MHT patients compared with hypertensive controls, whereas blood pressure, high-density lipoprotein cholesterol, and smoking habit were similar. Median estimated glomerular filtration rate was lower in MHT patients compared with normotensive and hyperten-sive controls (both P<.01). The annual incidence of all-cause mortality per 100 patient-years was higher in MHT patients (2.6) compared with normotensive (0.2) and hypertensive (0.5) controls (both P<.01). Mortality of patients with a history of MHT remains high compared with normotensive and hypertensive controls. Patients with MHT had a more favorable cardiovascular risk profile compared with hyper-tensive controls but a higher prevalence of renal insufficiency. J Clin Hypertens (Greenwich). 2014;16:122-126. ª2013 Wiley Periodicals, Inc. Malignant hypertension (MHT) is a hypertensive emergency characterized by severe hypertension and acute microvascular complications including grade III or IV hypertensive retinopathy. If left untreated, the 5-year survival rate is <5% mainly because of stroke, myocar-dial infarction, congestive heart failure, and end-stage renal disease. 1-3 With the availability of antihyperten-sive drugs and improved patient care, mortality has been markedly reduced to approximately 10% after 5 years. 2,4 This is still considerable, however, given the relatively young study populations, with an average age varying between 40 and 50 years at presentation. 2,5 Previous cohort studies, including our own, have shown that renal dysfunction is an important predictor of mortality in patients with MHT, 2,4 while other studies suggest a role of traditional cardiovascular risk factors such as excess smoking, decreased levels of high-density lipoprotein (HDL), and poor blood pressure (BP) control. 6-9 However, most of these studies lack a control population thereby limiting the internal validity. Nonetheless, insight into the excess risk of cardiovas-cular disease and mortality in patients with a history of MHT is required to identify which preventive measures may further improve outcome of this extreme phenotype of hypertension-related organ damage. Therefore, the principle aim of this study was to quantify the excess mortality risk in patients with a history of MHT. The second aim was to investigate whether traditional cardiovascular risk factors contribute to the increased risk. To this end, we compared cardiovascular risk factors and all-cause mortality of patients with a history of MHT with age-, sex-, and ...

Malignant hypertension: does this still exist?

“…Importantly, 5-year survival among MHT patients has improved dramatically over the decades and for patients diagnosed after 1997 it is now more than 90% [11]. When compared malignant and non-MHT all-cause mortality is higher, with kidney failure as the main cause of death among patients with MHT [12,13]. Nevertheless, since the new, more effective antihypertensives are in use, current prognosis performs better [2].…”

Clinical value of multiorgan damage in hypertensive crises: A prospective follow‐up study

“…A shift from the definition of MHT to hypertension‐MOD may prompt clinicians to make a definitive diagnosis and quickly initiate antihypertensive therapy to avoid poor outcomes. Although there are sufficient data for the prognosis of MHT, 13,15‐17 the clinical characteristics and outcomes of hypertension‐MOD are still not clear.…”

Does Anticomplement Therapy Have a Role in the Management of Malignant Hypertension?

“…With this strategy, the annual incidence rate of all-cause mortality remains 13-and 5-fold, respectively, of normotensive and hypertensive controls, and some patients continue to develop progressive renal failure despite a good degree blood pressure (BP) control. [1][2][3][4] Thus, a subset of patients with "malignant hypertension" do not do well with antihypertensive drugs alone and may require different strategies for management.…”