A Clinical Study on Malignant Hypertension

There is a group of patients with hypertension who end up with poor prognosis in a rather rapid course. This condition is referred to as “malignant hypertension”, which seems a term not clearly defined at present. It has long been discussed as to whether this is a type of essential hypertension taking a special course or another independent disease. There is a general tred, however, to believe that “malignant hypertension” is not an independent disease but a syndrome which develops from primary or secondary hypertension. In an attempt to shed some light to this controversial problem, we have investigated 416 cases, in which the prognosis was known, out of the 586 hypertensive cases which entered the Nagoya National Hospital during the period from January 1954 to June 1963. Forty three of the 416 cases were considered to be “malignant hypertension”. The major clinical findings in these cases were the presence of high diastolic pressures as well as high systolic pressures, hypertensioe retinopathy with papilledema and severe neurocirculatory symptoms such as headache and dizziness, Most patients belonged in younger age brackets, particularly in the third and fourth decades, and died in uremic states. On the other hand, these cardinal findings were not invariably present in those cases that invariably showed definite nephrosclerosis at autopsy. Therefore, from the clinical point of view, it seems more appropriate to consider “malignant hypertension” a syndrome rather than a disease entity. Moreover, because of the lack of findings suggestive of this condition in its early stage, it seemed impracticable to establish criteria to predict the final outcome of a hypertension at the time of initial examinations. Thus, as a compromise, it seems reasonable to handle a case characterized by the following findings as “premalignant hypertension”, that is, markedly high systolic as well as diastolic pressure that respond poorly to antihypertensive drugs, accompanying continuous deterioration of the renal function. For such cases, efforts should be made to remove or lessen any factors that are detrimental, and to give antihypertensive drugs which can afford an optimal effect, if available.