improving survival of malignant hypertension patients over 40 years background to examine changing demography and survival of patients with malignant phase hypertension mht over 40 yearsmethods patients from our mht registry whose survival status on 31 december 2006 was known were included with analyses conducted based on decade of mht diagnosisresults fourhundred and fortysix patients with mht overall mean sd age 482 129 years 655 male 647 whiteeuropean 204 african caribbean and 148 southasian were included no significant demographic differences at diagnosis were evident over the 40 years with the exception of a significant increase p 0001 in the proportion of mht among ethnic minorities southasian and afrocaribbeans there were no significant differences in mean systolic blood pressure sbp at presentation but baseline diastolic bp dbp was significantly lower after 1976 p 00001 the total number of personyears of observation was 57255 years with a median interquartile range iqr length of followup of 1038 3132512 months overall 203 patients 556 died 125 320 within 5 years of diagnosis there was a significant improvement in 5year survival from 320 prior to 1977 to 910 for patients diagnosed between 1997 and 2006 sbp and dbp improved significantly during followup p 00001 multivariate analyses revealed that age decade of mht diagnosis baseline creatinine and followup sbp were independent predictors of survival all p 00001conclusions demography and number of new cases of mht have not changed dramatically over the past 40 years fiveyear postmht survival has improved significantly possibly related to lower bp targets tighter bp control and availability of new classes of antihypertensive drugs