Abstract
This follow-up study was undertaken to obtain prospective data on the factors influencing mortality in a group of unselected consecutive patients with essential hypertension. Information of this type is indispensable to evaluate the course and prognosis of individual cases at their first visit and to make a plan for long-term management of this disease. Materials and Methods From 1956 to 1960, 2, 839 patients were admitted to the Second Medical Division of Tohoku University Hospital, of these 729 were hypertensive. Among these hypertensive patients, 313 were excluded from this study because of the following reasons ; secondary hypertension-224 complicated neoplastic disease on admission-13, death during hospitalization -28, and old age(over 70 years) on admission-48. A total of 416 patients with essential hypertension remained for prognostic evaluation in this study. By the end of this study, 404 cases, i.e. 97 per cent of the group, had been followed until death or for at least 4 years from admission. The duration of the longest followup was 9 years. In the case of death, the data and cause of death were investigated from their family and home doctors who issued death certificates. For the purpose of evaluating prognostic significance of various clinical and laboratory data which were obtained at the time of ad-mission, patients were classified according to the grading system discussed below. Blood pressure on admission was arbitrarily classified as grade I (below 179/99mmHg), grade 11 (180-199/100-119) and grade III (over 200/ 1 20). The involvement of the ocular fundi was classified as normal and group I to IV according to KEITH and WAGENER'S classification. The degree of cardiac enlargement deter-mined by radiogram of the chest was classified by cardio-thoracic ratios. Grade I indicates 1.90 or more, grade II 1.89-1.70, grade III 1.69-1.50 and grade IV 1.49 or less. Electrccardio-graphic patterns were classified as normal, borderline, non-specific ST-T changes, coronary heart disease, and left ventricular hypertrophy. Loft ventricular hypertrophy was subdivided further as grade I-high voltage, grade II-.high voltage with relatively low T waves, grade III -diphasic T waves with ST changes and grade IV-clearly inverted T waves with or without voltage or conduction defects. Notes were made in regard to whether or not patients had clinically normal hearts, signs and symptoms of congestive failure, or histories of angina pectoris or myocardial infarction. Presence of impaired renal function and albuminuria was also noted.
