Hypertension: severe: prognosis was good with treatment.

Clinical bottom line (level 1b)

  1. 75% of patients with severe hypertension who were treated survive up to 20 years.
  2. The risk of dying increased with older age and increasing creatinine levels.
Webster et al: Quarterly Journal of Medicine 1993; 86: 485-493
Expires August 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: hypertension clinic, university hospital, Scotland (1970-1989)

128 patients (aged mean 52 years, 60% male) with accelerated hypertension defined as:
  • elevated blood pressure (mean 220/130)
  • presence of bilateral linear or flame-shaped haemorrhages and/or cotton-wool spots

Patients typically received atenolol, followed by bendrofluazide, then hydralazine or nifedipine. Patients with left ventricular failure, advanced renal failure or other contraindications had methyldopa and frusemide.

Multivariate proportional hazards regression analysis was performed.

88% followed for ?1 to 29 years; mean 20
Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death ?1 to 29 years; mean 20 31/128 24%
    (17% to 32%)

    • 50% of deaths were from acute myocardial infarction and 13% from stroke.
    • The following risk factors were significantly associated with death (no relative risks given):
      • increasing age
      • increasing creatinine
    • prevalence of accelerated hypertension in a hypertension clinic = 128/3928 (3.3%: 2.7% to 3.8%)

    Citation

    1. Webster J, et al: Accelerated hypertension - patterns of mortality and clinical factors affecting outcome in treated patients. Quarterly Journal of Medicine 1993; 86: 485-493
    Contributor: Nick Shenker and Chris Ball, August 2000
    Reviewer:

    Clinical Question.
    Patient severe hypertension
    Intervention or Exposure risk factors
    Outcome death