| Malignant Hypertension and accelerated high blood | | | | or oral contraceptives; , beta-blockers, or |
| pressure are two emergency conditions which | | | | alpha-stimulants. Renal artery stenosis, withdrawal |
| should be treated promptly. Both conditions have | | | | of alcohol, pheochromocytoma {most |
| same outcome and therapy. However Malignant | | | | pheochromocytomas can be localized using CT |
| hypertension is a complication of high blood | | | | scan of the adrenals}, aortic coarctation, |
| pressure characterized by very elevated high | | | | complications of pregnancy and |
| blood pressure, and organ damage in the eyes, | | | | hyperaldosteronism are secondary causes of |
| brain, lung and/or kidneys. It differs from other | | | | hypertension. Main Investigations to access target |
| complications of hypertension in that it is | | | | organ damage are complete renal profile, BSR, |
| accompanied by papilledema. (Edema of optic disc | | | | Chest Xray, ECG, Echocardiography, CBC, Thyroid |
| of eye) Systolic and diastolic blood pressures are | | | | function tests. |
| usually greater than 240 and 120, respectively. | | | | Management: |
| While Accelerated high blood pressure is condition | | | | Patient is admitted in Intensive Care Unit. An |
| with high blood pressure, target organ damage, on | | | | intravenous line is taken for fluids and medications. |
| fundoscopy we have flame shaped hemorrhages, | | | | The initial goal of therapy is to reduce the mean |
| or soft exudates, but without papilledema. | | | | arterial pressure by approximately 25% over the |
| There are two things. Hypertensive Urgency and | | | | first 24-48 hours. However Hypertensive |
| Hypertensive emergency. In hypertensive | | | | urgencies do not mandate admission to a hospital. |
| urgency we don't see any target organ damage | | | | The goal of therapy is to reduce blood pressure |
| while in emergency we see target organ damage | | | | within 24 hours, which can be achieved as an |
| along with high blood pressure greater than | | | | outpatient department. Initially, patients treated |
| systolic >220. Now depending upon target organ | | | | for malignant hypertension are instructed to fast |
| damage you will decide whether you have | | | | untill stable. Once stable, all patients with malignant |
| hypertensive emergency or urgency. It is | | | | hypertension should take low salt diet, and should |
| essential to bring down high blood pressure in | | | | focus on weight lowering diet. Activity is limited to |
| hypertensive emergency immediately, while in | | | | bed rest until the patient is stable. Patients should |
| urgency, bring down blood pressure very rapidly is | | | | be able to resume normal activity as outpatients |
| not required. | | | | once their blood pressure has been controlled. |
| Pathogenesis of malignant hypertension is fibrinoid | | | | Hospitalization is essential until the severe high |
| necrosis of arterioles and small arteries. Red blood | | | | blood pressure is under control. Medications |
| cells are damaged as they flow through vessels | | | | delivered through an IV line, such as nitroglycerin, |
| obstructed by fibrin deposition, resulting in | | | | nitroprusside, or others, may reduce your blood |
| microangiopathic hemolytic anemia. Another | | | | pressure. An alternative for patients with renal |
| pathologic process is the dilatation of cerebral | | | | insufficiency is IV fenoldopam. Beta-blockade can |
| arteries resulting in increased blood flow to brain | | | | be accomplished intravenously with esmolol or |
| which leads to clinical manifestations of | | | | metoprolol. Labetalol is another common |
| hypertensive encephalopathy. Common age is | | | | alternative, providing easy transition from IV to |
| above 40 years and it is more frequent in man | | | | oral (PO) dosing. Also available parenterally are |
| rather than women. Black people are at higher | | | | enalapril, diltiazem, verapamil, Hydralazine is |
| risk of developing hypertensive emergencies than | | | | reserved for use in pregnant patients as it also |
| the general population. | | | | increases uterine profusion, while phentolamine is |
| Target organs are mainly Kidney, CNS and Heart. | | | | the drug of choice for a pheochromocytoma |
| So symptoms of Malignant hypertension are | | | | crisis. After the severe high blood pressure is |
| oligurea, Headache, vomiting, nausea, chest pain, | | | | brought under control, regular anti-hypertensive |
| breathlessness, paralysis, blurred vision. Most | | | | medications taken by mouth can control your |
| commonly heart and CNS are involved in | | | | blood pressure. The medication may need to be |
| malignant hypertension. The pathogenesis is not | | | | adjusted occasionally. |
| fully understood. Up to 1% of patients with | | | | Remember, It is very necessary to control |
| essential hypertension develop malignant | | | | malignant hypertension, otherwise it can lead to |
| hypertension, and the reason some patients | | | | life threatening conditions like Heart Failure, |
| develop malignant hypertension while others do | | | | Infarction, Kidney failure and even blindness. |
| not is unknown. Other causes include any form of | | | | If you want to know more about Malignant |
| secondary hypertension; use of cocaine, MAOIs, | | | | Hypertension, visit our site highbloodpressuremed. |