Management of Malignant Hypertension Complicated by Renal Insufficiency

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Abstract
Aggressive hypotensive-drug therapy combining a thiazide diuretic, hydralazine and guanethedine was used in 20 patients with malignant hypertension complicated by renal insufficiency. Eleven of the patients lived for one year, four for five years, and two for 7 1/2 years. One is still alive beyond eight years. The glomerular filtration rate remained stable at low levels for long periods in some of the patients. Eleven died of uremia. In patients surviving for only weeks or months, the arterioles and small arteries were most affected, whereas in those surviving for at least one year, the large arteries revealed the more striking pathological changes. We conclude that aggressive reduction of blood pressure does not necessarily result in deterioration of renal function and may prolong survival. (N Engl J Med 291:10–14, 1974)