Malignant Hypertension in North West India

A Hospital Based Study

Abstract

One hundred and thirty-five patients with malignant hypertension seen over a period of 11 years (1979 to 1989) at a referral hospital were analyzed to characterize the clinical features and etiology of this disease. Ninety male and 45 female patients with an average age of 38.2±1.4 years were studied. Malignant hypertension was the presenting feature in 68 patients. The etiology included essential hypertension in 88 patients and a secondary cause in 47 patients. Secondary causes included a renovascular etiology in 20 patients, renal parenchymal disease in 19, pheochromocytoma in 6 and Conn's syndrome and adrenal carcinoma in one patient each. Among the 20 patients with renovascular hypertension, Takayasu's arteritis was seen in 15 (75%). The mean age of patients with essential hypertension was 41.7+1.14 years while the mean age in patients with secondary hypertension was 33.2+1.96 years. Duration of pre-existing hypertension was longer in essential hypertensives (2.42+0.45 years) than in patients with secondary hypertension (1.27+0.41 years, ρ<0.05). Raised serum creatinine was seen in 93 patients. Seventy-seven patients had left ventricular hypertrophy on ECG. Ninety-six patients were followed for a period ranging from 18 months to 10 years (mean 32 months). Sixteen patients died during hospital stay while 6 patients died during the follow-up period. The deaths were related to the effects of uncontrolled hypertension including, renal failure (11), stroke (6), congestive cardiac failure (3) and myocardial infarction (1). Male sex, higher age at presentation and deranged renal function at presentation were associated with a poor outcome. Thus, essential hypertension is the most common cause of malignant hypertension in India. Takayasu's arteritis is the most common cause of secondary hypertension. Impaired renal function and poor compliance affect the prognosis of malignant hypertension adversely.