Hypertension is another name for high blood pressure. According to MedLine Plus, hypertension is referred to as malignant or accelerated hypertension if the lower number, also called the diastolic pressure, is above 130. In most instances, examination of the retina reveals blood and optic nerve swelling. Pressures this high are a true medical emergency, requiring prompt hospitalization. People who are at risk for malignant hypertension can prevent this from occurring by vigilantly monitoring their blood pressures, taking their blood pressure medications and working closely with their doctors.
Epidemiology
The University of Maryland Medical Center reports that one percent of the population experiences malignant hypertension. African-American men, kidney patients, persons with collagen vascular disorders and women with toxemia of pregnancy are at highest risk for malignant hypertension. Although the Merck Manual notes that this is "most common in men during their 40s and 50s and women during their 30s," there are many reports in the literature of children with malignant hypertension.
Dangers
According to a 2006 article in "Cardiology Clinics," malignant hypertension is often associated with end-organ damage. The New York Times expands on this, saying "the brain, eyes, blood vessels, heart, and kidneys may sustain damage." The tiny filters in the kidney known as glomeruli are highly susceptible to damage because these are no more than tiny capillaries. This damage to the kidney is permanent and can lead to renal failure.
Symptoms
The New York Times reports that patients with malignant hypertension often have blurry vision, changes in mental status such as restlessness, anxiety, decreased alertness and ability to concentrate, fatigue, sleepiness and confusion. Other body symptoms listed by the New York Times include chest pain, cough, decreased urinary output and headache. Seizures and shortness of breath may also be present.
Treatment
Malignant hypertension is usually treated in the intensive care unit. According to PostGraduateDoctor, the goals of therapy is to reduce the diastolic blood pressure to 100-110 mmHg. Reducing blood pressures too quickly can bring on it's own complications so close monitoring is important. There is a very wide array of short-acting blood pressure drugs that can be used including labetalol, denoldopam mesylate, hydralazine, enalapril, nitroprusside and others.
Follow-up
Once the hypertensive crisis is over, long-term follow up is critical to the patient's well being. The patient should be counseled as to diet, exercise and weight loss, if appropriate. A regime of blood pressure meds and monitoring may be implemented. Protocols for managing the consequences of malignant hypertension, such as renal damage need to be investigated.
References
- MedLine Plus: Malignant Hypertension
- University of Maryland Medical Center: Home > Medical Reference > Encyclopedia (English) Toggle: English / Spanish Ask the Expert Dr. Miller's Bio Image Get answers to your heart disease prevention questions. Ask Dr. Miller Dr. Miller's Bio | Q&A Archive Note: This is for informational purposes only. Doctors cannot provide a diagnosis or individual treatment advice via e-mail. Please consult your physician about your specific health care concerns. Video details Heart Center Virtual Tour Click to take a virtual tour Related Content * Audio/Video Library * Center for Preventive Cardiology * Laughter Good for Your Heart * Maryland Heart Center * Our Doctors Malignant Hypertension - Overview
- New York Times: Malignant Hypertension (Arteriolar Nephrosclerosis)
- Cardiology Clinics: Hypertensive Crisis: Hypertensive Emergencies and Urgencies.
- Journal Français d'Ophtalmologie: An Atypical Case of Malignant Hypertensive Retinopathy in a Young Child
