Survival and Mortality in Malignant (Grade Iv) and Grade Iii Hypertension

A series of malignant and other severe hypertensives (grade IV, 128 subjects, grade III, 177 subjects, according to the classification of Keith, Wagener and Barker) were submitted to energetic antihypertensive treatment, starting in October 1950. The patients have been followed from 5 to 17 years. Overall five‐year survival rates were in grade IV 50%, in grade III 61%. These results compare favorably with the results reported by other investigators. Subdividing the material into four consecutive patient groups, as regards the start of treatment, the most striking increase in five‐year survival in comparison with earlier untreated control material was observed already in the first group, starting treatment in the early fifties. The tendency to further improvement was rather slight. However, more advanced age and signs of more severe vascular damage in vital areas in the later patient groups might partly explain this, patients without such unfavorable factors showing a better prognosis in the last two groups. Of the four major causes of death, congestive failure was most markedly suppressed, cerebro‐vascular lesions and uremia clearly lowered, while myocardial infarction remained virtually unaffected. Measures discussed for further improving prognosis were active tracing and energetic treatment of less advanced stages of hypertensive disease, improved detection of impaired renal function, prophylactic measures against pyelonephritis and an aggressive approach to simultaneous control of other “coronary and cerebro‐vascular high risk factors” as defined by prospective studies.