Hypertension: hypertensive crisis indicated a poor prognosis.

Clinical bottom line (level 2b)

  1. 40% of patients with malignant hypertension were dead within 3 years, mainly from renal failure or stroke.
  2. Risk factors that indicated a worse outcome included:
    • serum urea 10 mmol/l or more
    • increasing duration of known hypertension
Lip et al: Journal of Hypertension 1995; 13: 915-924
Expires August 2003

The study

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

Setting: acute hospital, UK

315 patients (aged mean 49 years, 67% male) hypertension

Excluded if
  • no mention in clinical records of retinal changes
  • unilateral retinal features
  • papilloedema only




    • Crude multivariate regression analysis was performed for the following risk factors: race, age, duration of previous hypertension, smoking, alcohol consumption, blood pressure, proteinuria, haematuria, retinopathy score, serum urea, serum creatinine, ECG voltage, presence of left ventricular hypertrophy.

    83% followed for 1 to 389 months; mean 33 months
    Outcomes studied:
  • death
  • on haemodialysis

    • Patients were: 70% Caucasian; 17% black; 13% Asian

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death 1 to 389 months; mean 33 months 126/315 40%
    (35% to 45%)
    on haemodialysis 1 to 389 months; mean 33 months 10/315 3.2%
    (1.2% to 5.1%)

    • Risk factors significantly associated with death (no odds ratios given):
      • serum urea 10 mmol/l or more
      • increasing duration of known hypertension
    • Death caused by renal failure (40%); stroke (24%); MI (11%); heart failure (10%) and other (4%). 10% undocumented.
    • Good quality blood pressure control (DBP <100mmHg at follow-up) gave a better median survival time (53 versus 20 months, p<0.001).
    • There were no significant differences in mortality between smokers/non-smokers and tee-totallers/alcohol drinkers

    Comments

    1. Population around the study area is 83% Caucasian; 10% Black; 7% Asian. Caucasians tended to present older and with less renal failure.

    Citation

    1. Lip GY, et al: Complications and survival of 315 patients with malignant-phase hypertension. Journal of Hypertension 1995; 13: 915-924
    Search Terms: hypertensive crisis in PubMed
    Contributor: Nick Shenker and Chris Ball, August 2000
    Reviewer:

    Clinical Question.
    Patient hypertensive crisis
    Intervention or Exposure risk factors
    Outcome death