COMPLICATIONS AND SURVIVAL OF 315 PATIENTS WITH MALIGNANT-PHASE HYPERTENSION
COMPLICATIONS AND SURVIVAL OF 315 PATIENTS WITH MALIGNANT-PHASE HYPERTENSION
复制标题
DOI：
10.1097/00004872-199508000-00013
复制
发表时间：
1995-08-01
影响因子：
4.9
通讯作者：
BEEVERS, DG
中科院分区：
文献类型：
--
作者：
LIP, GYH;BEEVERS, M;BEEVERS, DG
目的：通过分析伯明翰市立医院自1965年以来收治的恶性高血压患者的预后，探讨影响恶性高血压患者生存的因素。结果：我们确定了315例恶性高血压患者（男性211例，女性104例;平均年龄± SD 49.4 ± 12.7岁）。在这些患者中，219名为白人，55名为黑人，41名为亚洲人。黑人患者在就诊时有更大的肾损害和更高的血压。中位随访期为33个月（范围1-389个月）后，126例患者（40.0%）仍然存活，126例患者（40.0%）死亡，10例患者（3.2%）正在接受长期血液透析，53例患者（16.8%）失访。死亡患者的平均随访血压明显高于存活患者。白人、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，黑人患者的生存时间最短。在有蛋白尿和高血清尿素（>10 mmol/l）和肌酐（> 200 μ mol/l）水平的患者中，如果心电图检测到左心室肥大，则中位生存时间较短，但有血尿和无血尿患者中位生存时间无差异，不吸烟者和当前或以前吸烟者中位生存时间也无差异。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年之前、1970-1979年期间和1980-1989年期间就诊的患者的中位生存时间分别为39.2、68.6和144.0+个月，表明1980年之后诊断的患者的生存时间有所改善。使用多变量考克斯的比例风险分析，已知的高血压和血清尿素水平在presentation的持续时间被发现是主要的预测survival.Conclusion：恶性高血压仍然是一种疾病，总体预后不良，即进展到死亡或慢性肾血液透析。随着治疗的最新进展，预后有所改善，5年生存率为74%。黑人患者的不良前景可以解释为他们晚期出现严重高血压和该组中较高的肾损害患病率。
Objective: 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.Results: 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 mu mol/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.Conclusion: 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.