From the Guidelines
Malignant hypertension is characterized by a severe blood pressure elevation, usually greater than 200/120 mmHg, accompanied by advanced retinopathy, including bilateral flame-shaped haemorrhages, cotton wool spots, or papilloedema. This condition is a hypertensive emergency that requires immediate attention to prevent or limit target organ damage, particularly to the heart, retina, brain, kidneys, and large arteries 1. The management of malignant hypertension involves prompt reduction of blood pressure to prevent further organ damage, with the goal of lowering blood pressure to a safe range without causing hypotension.
- Key features of malignant hypertension include:
- Severe blood pressure elevation (usually >200/120 mmHg)
- Advanced retinopathy (bilateral flame-shaped haemorrhages, cotton wool spots, or papilloedema)
- Potential for acute hypertension-mediated organ damage to critical organs
- The diagnosis of malignant hypertension is based on the presence of severely elevated blood pressure and evidence of end-organ damage, which may include symptoms such as seizures, lethargy, cortical blindness, coma, or signs of cardiac, renal, or vascular involvement 1.
- Treatment should be guided by the severity of the condition and the presence of specific organ damage, with the aim of gradually reducing blood pressure while avoiding too-rapid decreases that could lead to further complications.
From the Research
Definition of Malignant Hypertension
Malignant hypertension is a hypertensive emergency with excessive blood pressure elevation and accelerated disease progression, characterized by acute microvascular damage and autoregulation failure affecting various organs such as the retina, brain, heart, kidney, and vascular tree 2.
Blood Pressure Levels
Malignant hypertension is defined by extreme blood pressure elevation, with systolic blood pressure above 200 mmHg and diastolic blood pressure above 130 mmHg 3.
- Systolic blood pressure: above 200 mmHg
- Diastolic blood pressure: above 130 mmHg
Clinical Presentation
Malignant hypertension is the most severe form of hypertension, defined clinically by very high blood pressure accompanied by bilateral retinal hemorrhages and/or exudates, with or without papilledema 4.
- Bilateral retinal hemorrhages
- Retinal exudates
- Papilledema
Organ Damage
Malignant hypertension causes severe damage to various organs, including:
- Brain: significant brain damage found in 93% of patients 5
- Heart: left ventricular mass more than 60 g/m in 82% of patients, and systolic dysfunction in 56% of patients 5
- Kidneys: renal involvement in 55% of patients, and thrombotic microangiopathy in 15% of patients 5
- Eyes: bilateral retinal hemorrhages and/or exudates, with or without papilledema 4