What is malignant hypertension (arteriolar nephrosclerosis)?
Malignant hypertension is an acute emergency requiring immediate treatment in hospital. Whatever the underlying cause, when the blood pressure reaches a certain level for a sufficient length of time it sets off a vicious cycle of damage to the heart, brain, and kidneys, resulting in further elevation of the pressure. Not surprisingly, if untreated, it can be rapidly fatal.
Malignant hypertension is a complication of hypertension characterized by very elevated blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. It differs from other complications of hypertension in that it is accompanied by papilledema. Systolic and diastolic blood pressures are usually greater than 240 and 120, respectively. The most common presentations of hypertensive emergencies at an emergency department are chest pain (27%), dyspnea (22%), and neurologic deficit (21%). The primary cardiac symptoms are angina, myocardial infarction, and pulmonary edema. Orthostatic symptoms may be prominent. Neurologic presentations are occipital headache, cerebral infarction or hemorrhage, visual disturbance, or hypertensive encephalopathy (a symptom complex of severe hypertension, headache, vomiting, visual disturbance, mental status changes, seizure, and retinopathy with papilledema). Medications or drugs that may cause a hypertensive emergency include cocaine, monoamine oxidase inhibitors (MAOIs), and oral contraceptives; the withdrawal of beta-blockers, alpha-stimulants (such as clonidine), or alcohol also may cause hypertensive emergency. Renal disease may present as oliguria or any of the typical features of renal failure. Gastrointestinal symptoms are nausea and vomiting.
Once the diagnosis of hypertensive emergency is made, the most commonly used intravenous drug is nitroprusside. An alternative for patients with renal insufficiency is IV fenoldopam. Labetalol is another common alternative, providing easy transition from IV to oral (PO) dosing. Beta-blockade can be accomplished intravenously with esmolol or metoprolol. Hydralazine is reserved for use in pregnant patients, while phentolamine is the drug of choice for a pheochromocytoma crisis.
More information on high blood pressure
What is blood pressure? - Blood pressure or arterial blood pressure is the pressure (force per unit area) exerted by the blood on the walls of the blood vessels.
What is high blood pressure (hypertension)? - High blood pressure or hypertension means high pressure (tension) in the arteries. High blood pressure is generally defined as a level exceeding 140/90 mm Hg that has been confirmed on multiple occasions.
How to measure blood pressure? - Arterial blood pressure is usually measured in millimeters of mercury (mm Hg) using a sphygmomanometer.
What causes high blood pressure? - High blood pressure is far more common in families where other members have this condition. There are also many other factors which are related to high blood pressure.
At what level is blood pressure too high? - Blood pressure is generally felt to be abnormally high at a level of 140/90, and some sort of definitive therapy and follow-up should be started at this level.
What is "white coat syndrome"? - "White coat syndrome" is a situation where patients have high blood pressure in the doctor's office but nowhere else.
What're the symptoms of high blood pressure? - High blood pressure usually causes no symptoms. Sometimes people with high blood pressure have symptoms including headache, dizziness, blurred vision and nausea.
How is high blood pressure diagnosed? - The diagnosis of high blood pressure is made on the basis of many blood pressure readings. It is diagnosed if several readings show a systolic blood pressure greater than 140 or a diastolic blood pressure greater than 90.
What is isolated systolic hypertension? - Isolated systolic hypertension (ISH) is defined as elevated systolic blood pressure in conjunction with normal diastolic blood pressure (<90 mm Hg).
Why and how isolated systolic hypertension (ISH ) develops? - Factors that may play a role in the high prevalence of ISH seen in Western societies include increased body fat, sedentary lifestyle, and increased sodium intake.
What is white coat hypertension? - White coat hypertension should be considered when blood pressure readings are significantly elevated in the absence of target-organ damage.
What is borderline hypertension? - Borderline hypertension is a blood pressure level which is in the 'gray zone' between normal and high (for example, someone with an average pressure of about 140/90 mmHg).
What is malignant hypertension (arteriolar nephrosclerosis)? - Malignant hypertension is an acute emergency requiring immediate treatment in hospital.
What is labile hypertension? - 'Labile' means variable, and just about everyone with hypertension has 'lablie hypertension.'
What is pulmonary hypertension? - Pulmonary hypertension is high blood pressure in the pulmonary circulation (the arteries which go to the lungs). The blood pressure in the arms and the rest of the body is normal or low.
What is renovascular hypertension? - Renovascular hypertension is a secondary form of high blood pressure caused by a narrowing of the renal artery.
What're the risk factors for high blood pressure? - Controllable factors contribute to high blood pressure include sodium (salt) sensitivity, obesity and overweight, heavy alcohol consumption, use of oral contraceptives and some other medications, and sedentary or inactive lifestyle.
What're the complications of high blood pressure? - Blood vessels can narrow due to high blood pressure and the accumulation of cholesterol. Blockage of arteries in the brain can lead to stroke. Blockage of blood vessels in the kidneys can lead to kidney failure.
How does body weight affect hypertension? - Studies have shown that body weight, changes in body weight over time, and skinfold thickness are related to changes in blood pressure levels.
What're the treatment options for high blood pressure? - The goal of treatment is to reduce blood pressure to a level where there is decreased risk of complications. Treatment may occur at home with close supervision by the health care provider, or may occur in the hospital.
What medications are available for high blood pressure? - Medications may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or alpha blockers.
Which lifestyle modifications are beneficial in treating hypertension? - Lifestyle modifications refer to certain specific recommendations for changes in diet and exercise.
What is a good high blood pressure diet? - A good high blood pressure diet is not only rich in important nutrients and fiber but also includes foods that contain far more electrolytes, potassium, calcium, and magnesium, than are found in the average American diet.