Malignant hypertension natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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• Brain damage
• Heart damage, including:
  • Heart attack
  • Angina (chest pain due to narrowed blood vessels or weakened heart muscle)
  • Heart rhythm disturbances

• Kidney failure
• Permanent blindness
• Pulmonary edema (fluid in the lungs)

Prior to effective therapy, life expectancy was less than 2 years, with most deaths resulting from stroke, renal failure, orheart failure. The survival rate at 1 year was less than 25% and at 5 years was less than 1%. With current therapy, including dialysis, the survival rate at 1 year is greater than 90% and at 5 years is 80%. The most common cause of death is cardiac, with stroke and renal failure also common. The single greatest prognostic factor in malignant hypertension is renal function, with renal insufficiency secondary to malignant nephrosclerosis being strongly associated with poorer outcomes.

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