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The European Society of Hypertension defines malignant hypertension (MHT) as the «presence of very high blood pressure (BP) associated with ischemic organ failure (retina, kidney, heart or brain)». The aim of this study was to describe the biggest French cohort and study prognostic factors for End Stage Renal Disease (ESRD), major cardiovascular events and deaths.

Design and method:

This retrospective study was performed in Bordeaux – France – from 1995 to 2015.


One hundred and twenty fours patients with MHT (67.7 % males, mean age 46 years, average baseline BP = 206/118mmHg) were included. Median follow-up was 60 months. All patients were treated using at least a renin-angiotensin system blocker. Retinal impairment was found in 87% of subject (papilloedema in 60%). Heart involvement was found in 82%: important left ventricular hypertrophy (average left ventricular mass index was 87 g/m2,7 ± 29,36) and systolic dysfunction better assessed with global longitudinal strain (GLS) often severely impaired (mean GLS was 12.99 % ± 4.22). ECG showed abnormal repolarisation in 60%. Starting 2005, all patients had brain Magnetic Resonance Imaging (MRI); 69% showed a Posterior Regressive Encephalopathy Syndrome, asymptomatic most of the time. Creatinine level was > 150 μmol/l for 38% of our patients at admission. Proteinuria was low (mean Proteinuria/Creatinuria 78.1 mg/mmol ± 116.5). Renal function decreased for 17% of them during the follow-up. The incidence of ESRD or death was 12.41 % at 5 years, 27.33 % at 10 years and 43.48 % at 15 years. Patients without retinal anomalies were not different from the others. In a cox model, age (HR 1.005; p: 0.027) and creatinine level at discharge (HR: 1.0046; p: 0.01) were significantly associated to primary end-point.


These results show that retinal, cardiac and brain damages are very frequent in case of MHT. Age and creatinine level at discharge are significant prognostic factors. Retinal anomalies are not mandatory to the diagnosis of this acute hypertension with multi organ damage (hypertension-MOD). Brain MRI and echocardiography should be systematically performed in these patients to better characterize organ dysfunction as MHT is really a systemic disease.

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