Malignant Hypertension

Very high blood pressure that typically comes on suddenly and quickly

Aetiology

  • Most common the result of essential hypertension, but can also result from other secondary causes of hypertension
    • Common in those with connective tissue diseases e.g. SLE

Pathophysiology

  • The arterioles are badly damaged and undergo fibrinoid necrosis with resultant acute renal failure

Clinical presentation

  • Anxiety, confusion, decreased alertness, fatigue
  • Signs of increased ICP - headache, N+V
  • Blurred vision
  • Chest pain - crushing/ pressure
  • Cough
  • Reduced urine output
  • SOB
  • Paraesthesias and weakness of limbs/face

Investigations

  • Defined as systolic blood pressure of >180 mmHg and / or diastolic blood pressure of >120 mmHg PLUS signs of target organ damage

Management

  • Medical emergency - hospital admission and lowering of BP over a period of days

Complications

  • Papilloedema
  • Encephalopathy
  • Cardiac failure
  • Renal failure