The effectiveness of long-term treatment of malignant hypertension.

HYPERTENSION even of mild degree shortens life span. Thus Dublin, Lotka and Spiegelman1 in 1940 stated, "mortality rises steadily and markedly with increasing elevations of both the systolic and diastolic pressures'? and, '' ii the group with the highest blood pressures included in this [insurance] experience-and these are not considered seriously high by many clinicians-the mortality from cardiovascular renal disease was nearly 41/2 times the average for all standard risks." This actuarial experience has been supplemented by Bechgaard, Kopp, and Nielson,2 who have followed the clinical courses of 1,038 out-patients with hypertension over periods of from 16 to 22 years. As compared with a normotensive group, the patients with hyperteiision, especially the men, showed decreased survival with increasing levels of pressure and, at the end of an average follow-up of 19 years, there survived only one fifth of the men and about half the women. These impressive data on prognosis in hypertension should not obscure the fact that the outcome in individual cases of essential hypertension is highly unpredictable. Some patients, most of them women, may go through a normal or nearly normal span of life. However, a majority will die prematurely, not from hypertension or hypertensive vascular disease as such, but from complica-