Abstract
BackgroundMalignant hypertension is frequently complicated by renal insufficiency. Although the survival of this hypertensive emergency has improved, recent data on renal outcome and its predictors are lacking. We assessed renal outcome and its predictors in patients with malignant hypertension.MethodsRetrospective analysis of patients admitted with malignant hypertension in Amsterdam, the Netherlands between August 1992–January 2010. Follow-up data on vital status, renal function and blood pressure (BP) were obtained from the outpatient department and from general practitioners. The primary composite endpoint was end-stage renal disease (ESRD) defined as the start of kidney replacement therapy (KRT) or ≥ 50% decline of estimated glomerular filtration rate (eGFR). The secondary endpoint was all cause mortality.ResultsA total of 120 patients admitted with malignant hypertension were included. After a median follow-up period of 67 months (IQR 28 to 108 months) the primary endpoint was reached by 37 (31%) patients, whereas 18 patients (15%) reached the secondary endpoint. Twenty-nine (24%) patients started KRT and 8 patients (7%) had an eGFR decline ≥ 50%. After the acute phase (> 3 months after admission), initial serum creatinine and follow-up BP were the main predictors of future ESRD with hazard ratios of 6.1 (95% CI, 2.2–17) for patients with initial serum creatinine ≥ 175 μmol /L and 4.3 (95% CI, 1.4–14) for patients with uncontrolled hypertension.ConclusionsProgressive renal function decline leading to ESRD remains a major threat to patients with malignant hypertension. BP control during follow-up was an important modifiable predictor of renal outcome.
Highlights
Malignant hypertension is frequently complicated by renal insufficiency
Malignant hypertension is a hypertensive emergency usually defined by the presence of severe hypertension in combination with ischemic retinal changes consistent with grade III or IV hypertensive retinopathy according to the Keith, Wagener and Barker classification [1]
To identify the presence of registration errors, computer data of all patients discharged with the diagnosis ‘essential hypertension’ (ICD 401.9) were analyzed which showed the presence of one patient with malignant hypertension
Summary
Malignant hypertension is frequently complicated by renal insufficiency. The survival of this hypertensive emergency has improved, recent data on renal outcome and its predictors are lacking. We assessed renal outcome and its predictors in patients with malignant hypertension. Malignant hypertension is frequently complicated by renal dysfunction [2,3]. One would expect that because of advances in the awareness, treatment and control of hypertension in the population at large the incidence of malignant hypertension and its renal complications would have declined. We and others have shown that malignant hypertension remains relatively common in large multiethnic communities and in urban sub-Saharan African populations. Annual reports of the European Dialysis and Transplant Association and the US Renal Data System show that hypertension is an important cause of ESRD, but the role of hypertensive crises are not specified [9,10]
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