Hypertension - Malignant

A. Presentation

The fullblown syndrome include

• Severe acute hypertension (Diastolic BP >120mmHg)
• Renal failure
• Retinal haemorrhages and exudates, with or without papilloedema

B. Investigation

As per Hypertension.

C. Treatment

Treatment is to aim to limit acute end organ damage.

Rapid blood pressure reduction (over several hours) is required in some circumstances  (aortic dissection, severe pre-eclampsia). In other cases, gradual blood pressure reduction over several days is sufficient and usually safer.

To reduce blood pressure over several hours, consider:

• IV sodium nitroprusside; OR
• Glycerl trinitrate; OR
• Hydralazine.

To reduce blood pressure over several days, consider oral antihypertensive drugs, e.g. beta-blockers, ACE-inhibitors, long acting dihydropyridines.

Diuretics are NOT suitable because of risk of hypovolemia.

Avoid precipitous BP reduction (>20% reduction over 6 hours) to prevent myocardial ischemia, infarction or cerebral hypoperfusion or renal ischaemia/infarction.

D. Other notes

5% of hypertensive person have malignant hypertension.