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Journal of Hypertension Nov 1994The widespread use of antihypertensive medication and the increasing frequency of diagnosis of mild-to-moderate hypertension should mean that malignant-phase... (Comparative Study)
Comparative Study
INTRODUCTION
The widespread use of antihypertensive medication and the increasing frequency of diagnosis of mild-to-moderate hypertension should mean that malignant-phase hypertension should be becoming less common, and this trend has been reported elsewhere. No decline in the incidence of malignant hypertension has been apparent in our practice in a district general hospital in a city centre.
OBJECTIVE AND METHODS
To investigate the incidence and mode of clinical presentation of patients presenting with malignant hypertension, we performed a retrospective survey of the number of patients presenting with malignant hypertension to our hospital, over the 24-year period from 1970 to 1993. We identified a total of 242 patients (155 male, 87 female; mean +/- SD age 50.1 +/- 13.3 years) with malignant hypertension.
RESULTS
There were no significant differences in the number of patients presenting each year, the mean age or the presenting systolic and diastolic blood pressures over the period surveyed. At presentation, 131 patients (54.1%) had no previous history of hypertension; 161 (66.5%) were receiving no antihypertensive therapy and only 70 (28.9%) were receiving antihypertensive treatment (with no record of therapy in 11 patients). The most common presenting symptoms included visual disturbance in 62 (25.6%), headaches in 29 (12.0%), headaches and visual disturbance in 24 (9.9%), heart failure in 19 (7.9%), stroke or transient ischaemic attack in 17 (7.0%) and dyspnoea in 13 (5.4%), although 23 patients (9.5%) were asymptomatic. The most common presenting complications were heart failure [27 patients (11.1%)], stroke [23 patients (9.5%)], angina [10 patients (4.1%)], myocardial infarction [nine patients (3.7%)] and chronic renal failure [77 patients (31.7%)]. In the whole group the majority (147 patients, 60.5%) had no complicating clinical features. Primary or essential hypertension was the most common underlying cause in 137 patients (56.4%). Secondary causes of hypertension (mainly renal disease) were identified in 97 patients (39.9%).
CONCLUSION
Our experience suggests that malignant hypertension is still common, with a small proportion of hypertensives presenting each year. In particular, the incidence has failed to decline in Birmingham. The incidence rate in the population served by our hospital is approximately 1-2 cases per 100,000 per year. An awareness of the different presenting clinical features is required to allow better recognition and management of this life-threatening condition.
Topics: Aged; Aged, 80 and over; Antihypertensive Agents; Blood Pressure; Data Collection; Data Interpretation, Statistical; England; Female; Hematuria; Humans; Hypertension, Malignant; Incidence; Male; Middle Aged; Proteinuria; Retrospective Studies; Smoking; Social Class
PubMed: 7868878
DOI: No ID Found -
Australian and New Zealand Journal of... 1981
Topics: Angiotensin II; Animals; Antihypertensive Agents; Arginine Vasopressin; Diuresis; Humans; Hypertension, Malignant; Kidney; Natriuresis; Rats; Renal Artery; Sodium
PubMed: 6942804
DOI: No ID Found -
Hipertension Y Riesgo Vascular 2020Malignant arterial hypertension is still present in current clinical care despite the fact that for more than three decades we have had a wide range of antihypertensive...
Malignant arterial hypertension is still present in current clinical care despite the fact that for more than three decades we have had a wide range of antihypertensive drugs to control high blood pressure. It is essential to know how to detect it in time due to its high risk to life, with poor short-term prognosis if not treated properly. It may present with nonspecific, but potentially serious, clinical symptoms or manifest clinically as a hypertensive emergency accompanied by hypertensive encephalopathy and multi-organ failure. We present a case of a 49-year-old woman, attended in our hospital who had an initial hypertension of 223/170mmHg accompanied by multi-organ failure, who progressed satisfactorily with antihypertensive treatment.
Topics: Female; Humans; Middle Aged; Antihypertensive Agents; Hypertension, Malignant; Hypertensive Encephalopathy; Ventricular Dysfunction, Left
PubMed: 31735701
DOI: 10.1016/j.hipert.2019.10.002 -
American Journal of Kidney Diseases :... Aug 2010
Topics: Dialysis Solutions; Humans; Hypertension, Malignant; Renal Dialysis; Ultrafiltration
PubMed: 20659627
DOI: 10.1053/j.ajkd.2010.04.022 -
JAMA Sep 1970
Topics: Humans; Hypertension, Malignant; Hypertension, Renal; Renin
PubMed: 5468918
DOI: No ID Found -
Lancet (London, England) Jun 1972
Topics: Evaluation Studies as Topic; Humans; Hypertension, Malignant; Nephrectomy
PubMed: 4113447
DOI: 10.1016/s0140-6736(72)91084-7 -
The Medical Journal of Australia Oct 1974
Topics: Diazoxide; Drug Therapy, Combination; Humans; Hypertension, Malignant; Minoxidil; Propranolol
PubMed: 4444606
DOI: 10.5694/j.1326-5377.1974.tb71044.x -
American Journal of Nephrology 2000A 34-year-old Japanese male was admitted to Okayama University Hospital with severe hypertension, rapidly progressive renal failure, blurred vision, dyspnea and...
A 34-year-old Japanese male was admitted to Okayama University Hospital with severe hypertension, rapidly progressive renal failure, blurred vision, dyspnea and hemoptysis. Clinical diagnosis of malignant hypertension was given and antihypertensive therapy and hemodialysis were immediately started. Renal biopsy was performed on the sixth day in hospital to examine the underlying disease, such as microscopic form of polyarteritis, since the complaint of hemoptysis and pulmonary alveolar hemorrhage was noted by computed tomography of the lungs. Typical pathological changes of malignant hypertension, i.e. fibrinoid necrosis of the afferent arterioles and proliferative endoarteritis at the interlobular arteries were observed. There was no evidence of active necrotizing glomerulonephritis and crescent formation. Renal function was gradually recovered and pulmonary hemorrhage completely disappeared by treatment with antihypertensive agents. The authors report a case of malignant hypertension with a rare complication of pulmonary alveolar hemorrhage and speculate that it may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.
Topics: Adult; Biopsy; Hemorrhage; Humans; Hypertension, Malignant; Kidney; Lung Diseases; Male
PubMed: 10644871
DOI: 10.1159/000013558 -
Lancet (London, England) Jun 1991
Topics: Bloodletting; Erythropoietin; Humans; Hypertension, Malignant
PubMed: 1675730
DOI: 10.1016/0140-6736(91)93300-x -
Lancet (London, England) May 1991
Topics: Bloodletting; Erythropoietin; Humans; Hypertension, Malignant; Recombinant Proteins
PubMed: 1673767
DOI: 10.1016/0140-6736(91)92901-d