Prognostic factors in malignant hypertension selected by multivariate analysis.

This study determines the prognostic factors involved in both patient and kidney survival rates in 97 consecutive patients admitted for malignant hypertension (diastolic blood pressure > or =130 mmHg and stage 3 or 4 retinopathy according to Keith-Wegener classification) between January 1976 and December 1987. For this we used the Cox's proportional hazards regression model to specify the independent covariates linked to the patient and renal survival rates. Renal death referred to endstage renal disease treated with dialysis or transplantation (i.e., probability of surviving without dialysis or transplantation). The following covariates were entered into the Cox's model: sex, duration of hypertension before malignant phase, age, serum creatinine, stages 3 and 4 fundi, diastolic blood pressure, cardiac and neurological involvements, extrarenal atheromatous disease, aetiology of the malignant hypertension (primary, secondary to parenchymal nephropathy, and secondary to renovascular abnormalities), all these covariates being recorded during the initial admission; and mean diastolic blood pressure during the period the patients were observed. At the final follow-up, we had no record of five patients. At 5 years the cumulative survival rates were 75% in the case of patients and 65% for the renal function. Age, mean diastolic blood pressure during the observation period, and serum creatinine increase independently and significantly the risk of patient death. On the other hand the risk of renal death is decreased by neurological involvement.