MALIGNANT HYPERTENSION IN THE ELDERLY

To investigate age-related differences in malignant hypertension (MHT) , we studied 38 elderly patients (18 males, 20 females; mean age 70.6 years, SD 4.6 years, range 65 to 84) and 277 younger patients (193 mal es, 84 females; mean age 46,4 years, SD 10.5, rang 15 to 64) with MHT presenting 1965-93. Mean duration of known hypertension before present ation was greater in the elderly group (43.8 months vs. 23.1 months). The elderly group included 18 (47.4%) newly diagnosed hypertensives, c ompared to 160 (55.8%) in the younger group. At presentation, 19 (50.0 %) elderly patients were receiving no antihypertensive drug therapy, w hilst 18 (47.4%) were taking one or more drugs for hypertension. Prese nting clinical features in elderly MHT patients included visual distur bance (9), headaches (2), headaches with visual disturbance (2), strok e (3), and heart failure (2). Six patients were asymptomatic. The comm onest clinical complications were ischaemic heart disease (angina and myocardial infarction) (5), heart failure (4) and stroke (4). The majo rity (58%) of patients, however, had no vascular complications at pres entation. Comparing elderly and younger MHT groups, there was no signi ficant difference in presenting systolic blood pressures, although mea n diastolic blood pressure was significantly greater in the younger gr oup (mean 143.7 mmHg +/- 19.3 vs. 130.0 mmHg +/- 15.2; p < 0.0001). Af ter a mean follow-up of 30.9 months (SD 37.1; range 1 to 123 months), 17 (44.7%) of the elderly patients were still alive, 15 were dead (39. 5%) and six were lost to follow-up. The commonest causes of death in t he elderly group were cerebrovascular events (stroke) in three patient s, renal failure in two and heart disease (myocardial infarction/heart failure) in three patients. Lifetable analyses showed a median surviv al of 72.8 months for the elderly patients with MHT, not significantly different from that of 111.2 months for the younger group (Lee-Desu s tatistic 0.332, p = 0.56). MHT is a condition that can present for the first time in elderly people. Elderly patients with MHT have in gener al similar presenting clinical features, complications and survival co mpared to younger patients, and should therefore be treated as intensi vely.