The classic paper by Keith, Wagener, and Barker 1 in 1939 as well as other studies 2-7 of the natural course of severe hypertension have shown that the prognosis in untreated cases is poor. In the series of Keith, Wagener, and Barker, 79% of 145 patients with malignant hypertension (group 4) were dead within one year and only one patient survived for five years after the diagnosis was made (Figure).
Effective hypotensive drugs have been available for nearly ten years, but only recently has enough experience with treatment of large groups of severely hypertensive patients over a long period been available from which the efficacy of prolonged drug therapy can be evaluated. Several such studies indicate that intensive treatment with ganglion-blocking agents prolongs life.5-16 The current study was undertaken in an attempt to evaluate the effect of hypotensive therapy for patients with group 3 and group 4 hypertension, for
FARMER RG, GIFFORD RW, HINES EA. Effect of Medical Treatment of Severe HypertensionA Follow-Up Study of 161 Patients With Group 3 and Group 4 Hypertension. Arch Intern Med. 1963;112(1):118–128. doi:10.1001/archinte.1963.03860010144016
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