Malignant Hypertension : Aetiology and Outcome in 83 Patients

Yu, Suk-Hee; Whitworth, J. A.; Kincaid‐Smith, Priscilla

doi:10.3109/10641968609045483

Cited by 32 publications

(30 citation statements)

References 16 publications

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“…22,23 smoking has not been found to be an important factor in our study. This is in keeping with the generally low levels of smoking reported in Nigerians.…”

Section: Discussionmentioning

confidence: 38%

Factors influencing the development of malignant hypertension in Nigeria

2000

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Hypertension prevalence rates remain comparatively low in Nigeria, although the associated morbidity and mortality including that due to malignant hypertension (MHT) is considerable. To determine the factors that may be associated with the development of MHT we compared 74 patients with essential MHT (age 48 ؎ 9 years, 59 male, blood pressure (BP) 234 ؎ 31/140 ؎ 17 mm Hg) with 74, age, gender and BP-matched patients with essential benign hypertension (BHT) (49 ؎ 8 years, 60 male, 227 ؎ 26/136 ؎ 15 mm Hg). Body mass index was higher in the MHT group by 1.3 (95% Cl: 0.5 to 2.1, P Ͻ 0.01). In the subset (25 MHT, 43 BHT) in whom hypertension had been diagnosed before presentation, duration of hypertension was shorter (P Ͻ 0.05) in the Keywords: malignant hypertension; risk factors; black Nigerians IntroductionMalignant hypertension (MHT) remains a common condition in some populations, 1,2 and although its prognosis may be improving, it is still associated with considerable morbidity.1 Very high blood pressure (BP) is required for the development of MHT, but since the BP alone does not distinguish non-malignant, benign hypertension (BHT) from MHT and both conditions may exist at similar BP, other factors are clearly in operation.3-5 Some of these may relate to the kidney or vasculature, 3 the immune system 4 and to external or environmental differences.5 It may be possible to manipulate these external variables and prevent the transition to the malignant phase. Prevention of the transition to the malignant phase would reduce the morbidity and mortality attributable to hypertension, since the prognosis is worse in MHT. 6,7 This study aims at identifying these external factors in black Nigerian hypertensives, a group that is arguably underserved. Patients and methodsA record has been kept of the cases of MHT seen in over 10 years. MHT was diagnosed on the basis of severe hypertension with bilateral retinal exudates and haemorrhages with or without papilloedema. 8,9 A detailed account of the clinical presentation of some of the patients has been published elsewhere. 10Patients with secondary causes of hypertension were excluded. Secondary hypertension was excluded on the basis of history, physical examination, urine examination, serum electrolytes, renal ultrasound and renal arteriography as presented in the earlier study. 10 The presence of primary renal disease was suggested by the presence of urinary red cells, red and white cell casts, granular casts and proteinuria up to 1.5 g/24 h. 11 Where there was some doubt as to the cause of the hypertension, such patients were excluded. Accordingly, 74 patients were considered to have primary MHT. These patients were compared with 74 age, gender and BPmatched controls with benign essential hypertension newly presenting at the hypertension clinic. They necessarily had repeatedly high BP readings and grade 3 hypertension. 12Age, gender, body mass index (BMI), socio-economic group, BP, serum creatinine, history of smoking and alcohol use, perception of stress, known duration o...

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“…22,23 smoking has not been found to be an important factor in our study. This is in keeping with the generally low levels of smoking reported in Nigerians.…”

Section: Discussionmentioning

confidence: 38%

Factors influencing the development of malignant hypertension in Nigeria

2000

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“…1 Safe and effective antihypertensive drugs were first developed in the 1960s and were shown to dramatically improve the prognosis associated with malignant hypertension. 2,3 Over the next few decades, the widespread use of an expanding armamentarium of blood pressure-lowering drugs to patients at risk of malignant hypertension effectively eradicated this condition from most developed countries. Subsequently, the provision of blood pressure-lowering treatments to a much broader group of patients at risk of serious cardiovascular diseases, such as stroke and coronary heart disease, among whom blood pressure levels were often only modestly elevated, contributed importantly to the declines in stroke and coronary disease deaths rates experienced by most Western populations.…”

mentioning

confidence: 99%

The Burden of Blood Pressure-Related Disease

Perkovic

Huxley²,

Wu³

et al. 2007

Hypertension

281

124

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“…[10,11] IgAN is the most common form of primary glomerulonephritis among patients undergoing renal biopsy and is also one of the major causes of secondary malignant hypertension and ESRD. [20][21][22][23][24] In patients with IgAN-MHT, we previously found that the ischemic lesions and the glomerular background lesions both contributed to the impairment of renal function at presentation. [11] In the literature, it was reported that the genetic variants in the chromogranin A promoter were not only associated with hypertension, but also with hypertensive ESRD in primary hypertension [7,8] ; therefore, whether CHGA gene genetic variants affect onset of malignant hypertension and target-organ damage in secondary MTH raised special interest.…”

Section: Discussionmentioning

confidence: 99%

Common Genetic Variants in the Chromogranin A Promoter Are Associated with Renal Injury in IGA Nephropathy Patients with Malignant Hypertension

Jiang

Zhou

et al. 2010

Renal Failure

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The present study aimed to investigate whether genetic variants in the chromogranin A (CHGA) promoter were associated with malignant hypertension (MHT) and renal functional damage. The polymorphisms of CHGA promoter in 39 patients with malignant hypertension secondary to idiopathic IgA nephropathy (IgAN-MHT), 23 patients with primary malignant hypertension and 63 controls were genotyped by sequencing. Four diploid genotypes with minor allele frequencies of approximately ≥10% for individual CHGA SNP loci or haplotypes were compared among the patient with IgAN-MHT, primary MHT and healthy control. Polymorphisms and haplotypes of CHGA promoter were not associated with primary MHT and IgAN-MHT. Within 39 IgAN-MHT patients whose clinical and histological data were available, patients carrying −415TT genotype tended to present with higher serum creatinine (Scr) level than those carrying −415TC/CC genotype (636.94 ± 524.07 μmol/L vs 277.84 ± 196.39 μmol/L, P = 0.014). Consistent with this statistic, we found the haplotype-specific score value of haplotype ATC was 2.25046 (p = 0.024), and by permutation testing, the empirical p value was 0.014. The present study suggested the genetic variants in the chromogranin A promoter may not involve in the onset of malignant hypertension, but the variants might play a role in the renal dysfunction in patients with IgAN-MHT.

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Malignant Hypertension : Aetiology and Outcome in 83 Patients

Cited by 32 publications

References 16 publications

Factors influencing the development of malignant hypertension in Nigeria

Factors influencing the development of malignant hypertension in Nigeria

The Burden of Blood Pressure-Related Disease

Common Genetic Variants in the Chromogranin A Promoter Are Associated with Renal Injury in IGA Nephropathy Patients with Malignant Hypertension

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