Malignant Hypertension: Symptoms and Treatment

What is Malignant Hypertension?

Malignant hypertension is a medical emergency characterized by extremely high blood pressure and organ damage, particularly affecting the eyes, brain, lungs, and kidneys. It is distinguished by the presence of papilledema, or swelling of the optic disc. Blood pressure readings often exceed 240/120 mmHg.

Key Characteristics:

• Blood Pressure: Systolic > 240 mmHg, Diastolic > 120 mmHg
• Organ Damage: Eyes, brain, lungs, kidneys
• Unique Feature: Papilledema

Accelerated Hypertension

Accelerated hypertension also involves high blood pressure and organ damage but lacks papilledema. It presents with flame-shaped hemorrhages or soft exudates in the eyes.

Differences from Malignant Hypertension:

• No Papilledema: Unlike malignant hypertension
• Similar Organ Damage: But less severe

Hypertensive Urgency vs. Emergency

• Hypertensive Urgency: High blood pressure without organ damage. Immediate reduction is not critical.
• Hypertensive Emergency: High blood pressure with organ damage. Requires immediate intervention.

Causes and Risk Factors

The exact cause of malignant hypertension is unclear, but several factors can contribute:

• Primary Hypertension: Up to 1% of patients with essential hypertension develop malignant hypertension (source).
• Secondary Hypertension: Conditions like renal artery stenosis, pheochromocytoma, and aortic coarctation.
• Substance Use: Cocaine, MAOIs, oral contraceptives.
• Demographics: More common in men over 40 and Black individuals.

Symptoms

• Kidneys: Oliguria (reduced urine output)
• CNS: Headache, nausea, vomiting, blurred vision, paralysis
• Heart: Chest pain, breathlessness

Diagnosis

To assess organ damage, doctors may perform:

• Renal Profile
• Blood Sugar Levels (BSR)
• Chest X-ray
• ECG and Echocardiography
• Complete Blood Count (CBC)
• Thyroid Function Tests

Treatment

Immediate Care

• Hospitalization: Intensive Care Unit (ICU) admission
• IV Medications: Nitroglycerin, nitroprusside, or fenoldopam for renal insufficiency
• Beta-Blockers: Esmolol, metoprolol, or labetalol
• Special Cases: Hydralazine for pregnant patients, phentolamine for pheochromocytoma

Long-term Management

• Diet: Low-salt, weight-reducing diet
• Activity: Bed rest until stable, then gradual return to normal activities
• Medication Adjustment: Regular monitoring and adjustment of oral antihypertensives

Complications

Without treatment, malignant hypertension can lead to:

• Heart Failure
• Infarction
• Kidney Failure
• Blindness

Conclusion

Malignant hypertension is a life-threatening condition that requires immediate medical attention. Understanding its symptoms, causes, and treatment options can help manage and prevent severe complications. For more detailed information, consult reputable sources like the American Heart Association or Mayo Clinic.

This article provides a detailed overview of malignant hypertension, emphasizing the importance of prompt treatment and ongoing management to prevent serious health outcomes.