The Pathology of Sudden Death in Hypertensive Individuals

Abstract

A study of sudden death in hypertensive individuals was carried out with reference to the case files of the Office of the Medical Examiner of Metropolitan Dade County, Miami, Florida, USA, during 1984. All autopsied cases in which the primary or contributory cause of death included hypertensive cardiovascular disease or its sequelae (e.g. intracerebral haemorrhage) were collected. These autopsied cases were then analysed as to age, race, Hispanic surname, sex, cause of death listed on the death certificate, and alcohol content at autopsy. In addition, the total body height, total body weight, fresh heart weight and fresh kidneys weight were categorized as was the degree of patency of the coronary arteries. Furthermore, past medical history, duration of any illness, and any medication noted at the scene of death were also tabulated. Briefly, these 182 autopsied cases represented approximately half the 422 cases of hypertension examined by this office, and represented 7.2 per cent of autopsies performed in that year. Most cases involved persons over 40 years of age, having a non-Hispanic surname, being white and male, and who died from atherosclerosis and hypertension, hypertension alone, or intracranial haemorrhage, with negative blood alcohol present in 44.5 per cent of the cases studied. The mean heart weight was 504–5 gm (S.D. = 162 gm), the mean right kidney weight was 179.9 gm (S.D. = 52.4 gm) and the mean left-kidney weight was 183.6 gm (S.D. = 59 gm). Histologically, fibrosis of the heart and arteriolonephro-sclerosis or arteriolar sclerosis of the kidneys were frequently seen. Quantitatively, the degree of involvement of atheromatous plaque in the coronary arteries was evenly divided among all degrees of severity. Most cases had a past medical history conducive to developing hypertension for an undocumented amount of time. Medication at the scene of death was absent in 65 per cent of the cases. Furthermore, the blood pressure was not documented in 73.6 per cent of cases. Discussion follows concerning the role of the medical examiner in such cases and the nature of that material not frequently studied by clinicians.