Factors influencing the development of malignant hypertension in Nigeria

Hypertension prevalence rates remain comparatively low in Nigeria, although the associated morbidity and mortality including that due to malignant hyp ertension (MHT) is considerable. To determine the factors that may be assoc iated with the development of MHT we compared 74 patients with essential MH T (age 48 +/- 9 years, 59 male, blood pressure (BP) 234 +/- 31/140 +/- 17 m m Hg) with 74, age, gender and BP-matched patients with essential benign hy pertension (BHT) (49 +/- 8 years, 60 male, 227 +/- 26/136 +/- 15 mm Hg). Bo dy mass index was higher in the MHT group by 1.3 (95% CI: 0.5 to 2.1, P < 0 .01). In the subset (25 MHT, 43 BHT) in whom hypertension had been diagnose d before presentation, duration of hypertension was shorter (P < 0.05) in t he MHT group. Patients with MHT, were more likely to have been receiving in adequate therapy in the months before (OR 2.7, 95% CI: 1.4 to 5.4), showed a decreasing proportion with increasing socio-economic class (chi(2) = 5.79 , Pt 0.02) and had been exposed to a greater degree of stress (OR 3.5, 95% CI: 1.7 to 7.1). Smoking (OR 1.1, 0.6 to 2.3), alcohol use (OR 0.9, 0.5 to 1.8) and contraceptive pill use (OR 0.9, 0.1 to 8.6) did not impart excess risk. MHT is associated with the underprivileged and measures aimed at rais ing the general awareness and the socio-economic level of the people are ex pected to produce a decline in the incidence of MHT.