Lack of impact of pulse pressure on outcomes in patients with malignant phase hypertension: the West Birmingham Malignant Hypertension study

Objective: To investigate the impact of pulse pressure at presentation on the primary outcome (death or dialysis) in patients with malignant phase hypertension (MPH). Methods: Three hundred and sixty-five patients [overall mean (SD) age 48 (13) years; 66% male; 63% white European; 23% African-Caribbean, 14% south Asian] from the West Birmingham MPH study were included. Baseline pulse pressure was divided into quartiles. Two hundred and forty-two primary outcomes (death or dialysis) occurred during a median (interquartile range) follow-up of 7 (1.5-14.8) years. Results: Significantly higher pulse pressure was evident among older patients and white Europeans. Baseline BMI (P=0.49), retinopathy (P=0.56), proteinuria (P=0.61), haematuria (P=0.56) and left ventricular hypertrophy (P=0.43) were not related to pulse pressure. Multivariate analyses found that baseline age [hazard ratio (95% confidence intervals] [1.05 (1.04-1.06); P <0.0001], smoking [1.60 (1.16-2.21); P=0.004], proteinuria [1.33 (1.10-1.61); P=0.003] and creatinine level [1.002 (1.0011.002); P <0.0001] were independent predictors of the primary outcome of 'death or dialysis'. A multivariate analysis also revealed that independent predictors of future dialysis alone were as follows: baseline age [0.92 (0.89-0.95); P <0.001) and haematuria [2.74 (1.17-6.42); P=0.02), with a trend seen for baseline creatinine levels [1.001 (1.000-1.002); P=0.052)]. Pulse pressure at baseline did not predict death or dialysis. Conclusion: Age, smoking status and severity of renal failure at presentation with MPH (represented by proteinuria and creatinine levels) are independent predictors of the risk of death or dialysis. Pulse pressure at presentation does not predict death or dialysis in patients with MPH. Careful monitoring of renal functioning and effective management of blood pressure is mandatory in patients with MPH to prevent/slow future complications.