Malignant Hypertension Information

Malignant Hypertension Information

Question. Write a short note on malignant hypertension.

Answer. Malignant hypertension is a complication of hypertension characterized by very elevated blood pressure and organ damage in the eyes, brain, lungs, and kidneys.

It differs from other complications of hypertension in that it is accompanied by papilledema.

Systolic and diastolic blood pressure are usually greater than 240 and 140 mm Hg.

Malignant hypertension is a hypertensive emergency.

Etiology

1. Drugs, i.e., cocaine, beta­blockers, and oral contraceptives
2. Alcohol
3. Atherosclerosis
4. Chronic diabetes mellitus
5. Renal failure.

Clinical Features Acute Rheumatic Mitral Stenosis.

1. Chest pain is present
2. Dyspnea
3. Neurological defect
4. Angina and myocardial infarction
5. Pulmonary edema
6. Headache
7. Cerebral hemorrhage or infarction
8. Visual disturbance
9. *Hypertensive encephalopathy
10. Gastrointestinal symptoms, i.e. nausea and vomiting.
11. Oligurea.

Diagnosis acute rheumatic mitral stenosis.

1. Complete blood count
2. Coagulation profie
3. Electrolyte profie
4. Urine output and electrolytes
5. TSH
6. Renal function test
7. Chest radiograph
8. Head CT scan
9. ECG to see ischemia and infarction.

Treatment acute rheumatic mitral stenosis.

Since malignant hypertension is a medical emergency, it requires immediate treatment.

1. Most effective agent for blood pressure reduction in an emergency is controlled IV infusion of sodium nitroprusside, i.e. 0.3 to 1.0 µg/kg/min.
2. Alternatively diazoxide 300 mg I.V. or enalaprilat 1.25 mg IV is given rapidly and anti-hypertensive effct is noted under 1 to 3 min.
   The same dose is repeated when pressure begins to elevate.
3. Chewing a nefiipine l0 mg capsule is often suffient to give a graded reduction in blood pressure.
4. Bed rest should be given to the patient.
5. Sedation by IV diazepam is given.
6. A potent diuretic, i.e. IV frusemide 40 mg stat can also be given.