Analysis of 30 patients with malignant hypertension treated with hemodialysis.

KANEDA, H., MURATA, T., MAETA, T., MATSUMOTO, J., SHITOMI, K. and HARUYAMA, T. Analysis of 30 Patients with Malignant Hypertension Treated with Hemodialysis. Tohoku J. exp. Med., 1981, 134 (2), 169-181-For the past 7 years we have treated 30 patients with malignant hypertension with hemodialysis. The diagnosis of the disease was made according to the criteria recommended by the Ministry of Public Welfare, Japan, as described below. These patients were divided into three groups according to the therapies. Group A (15 patients) were medicated with large doses of β-blockers for the control of hypertension. Characteristic features of this group were abnormally high reninemia, hyponatremia, and severe hypertension which were not controlled by large doses of β-blockers in combination with dialysis. Their body weights were quite subnormal. Twelve patients out of 15 had essential hypertension (EH) as an underlying disease, and the remaining 3 had chronic glomerulonephritis (CN). Ten patients out of 15 died of hypertensive heart failure or hypertensive cerebrovascular accidents. Group B (6 patients) were treated by β-blockers intermittently. They showed good results responding well to the treatment; high reninemia was brought down to normal level by the administration of β-blockers and dialysis. Their underlying diseases were EH (3 patients) and CN (3 patients). Group C (9 patients) did not receive β-blockers, because hypertension was easily controlled by dialysis alone. In the Group C patients, normoreninemia, normonatremia, and a favorable clinical course were characteristic. Their underlying disease was CN in all. From these results, it is concluded that the factors influencing the prognosis of the disease may be the existence of EH as an underlying disease, high reninemia, and hyponatremia which are not correctable either by administration of β-blockers or by hemodialysis.