Rice Diet Improves Survival, Blood Pressure, and Eye Changes in 544 Patients with Malignant-Hypertension

BackgroundThe sodium-restricted rice diet (RD) was once the only effective treatment for malignant hypertension (MH); however, a modern, comprehensive data analysis is lacking. We determined patient survival and ocular improvements in 544 MH patients treated between 1942-1982. MethodsAt entry, systolic blood pressure (SBP) was [&ge;]170 mmHg and retinal hemorrhage (n = 312), hemorrhage with papilledema (n= 211) or papilledema alone (n = 21) were present. Dates of death were available for 454 patients; ocular data (at baseline and again before day 365) for 342 patients with hemorrhage and 143 with papilledema. We used actuarial analysis to determine survival and resolution of ocular findings. We used Cox proportional hazards to calculate mortality hazard ratio (HR), and period life tables to estimate loss of longevity. ResultsMedian initial SBP of 213.3 mmHg fell to 178.4 during year 1, and to [~]143 after 9 years. RD patients survived longer than untreated patients: 1890 vs 540 days for patients with hemorrhage alone; 510 vs 180 days with both hemorrhage and papilledema. Few patients reached their expected longevity; median loss of potential life was 15.4 years. Compared to patients whose SBP fell <15 mmHg by 4 weeks, those with a fall [&ge;] 37 mmHg had HR for mortality of 0.32. Retinal hemorrhages cleared in 260/342 patients; papilledema, in 133/143. ConclusionWith RD treatment blood pressure decreased, and ocular abnormalities largely resolved. Survival improved, but predicted longevity was not achieved. The RD helped MH and could still provide a useful adjunct to pharmacologic therapy.