Malignant hypertension and accelerated hypertension are two emergencies that need immediate treatment. Both illnesses have the same results and the same treatments. However, malignant hypertension is a complication of hypertension characterized by very high blood pressure and organ damage in the eyes, brain, lungs, and / or kidneys. It differs from other complications of hypertension in that it is accompanied by papilledema. (Edema of the optic disc of the eye) Systolic and diastolic blood pressure usually exceed 240 and 120, respectively. Acceleration of high blood pressure is a condition that involves high blood pressure and damage to target organs, but fundus examination shows burning bleeding or soft exudate, but no papilledema.
There are two things:
Hypertensive emergency and hypertensive emergency. In an emergency of hypertension, no damage to the target organ is seen, but in an emergency, damage to the target organ is seen with hypertension> systole> 220. Here, determine whether it is a hypertensive emergency or an emergency, depending on the damage to the target organ. It is important to lower blood pressure immediately in an emergency with high blood pressure, but in an emergency it is not necessary to lower blood pressure very quickly.
The etiology of malignant hypertension is fibrinoid necrosis of arterioles and arterioles. Red blood cells are damaged as they flower through blood vessels blocked by fibrin deposits, causing microangiopathic hemorrhagic anemia. Another pathological process is dilation of the cerebral arteries, which leads to increased blood flow to the brain, leading to the clinical manifestations of hypertensive encephalopathy. The normal age is over 40 and occurs more often in men than in women. Blacks are at greater risk of developing a hypertensive emergency than the general population.
The target organs are mainly the kidneys, central nervous system, and heart. Therefore, symptoms of malignant hypertensive oligolea, headache, vomiting, nausea, chest pain, shortness of breath, paralysis, blurred vision. The heart and central nervous system are most often involved in malignant hypertension. The cause is not fully understood. It is unclear why up to 1% of patients with essential hypertension develop malignant hypertension, some develop malignant hypertension, and others do not. Other causes include all forms of secondary hypertension. Use of cocaine, MAO inhibitors or oral contraceptives; beta blockers or alpha stimulants. Renal artery stenosis, alcohol withdrawal, pheochromocytoma (most pheochromocytomas can be found on CT scans of the adrenal glands), aortic stenosis, pregnancy complications, and hyperaldosteronism are secondary to hypertension It is the cause. The main tests to access target organ damage are complete renal profile, BSR, chest x-ray, ECG, echocardiography, CBC, and thyroid function tests.
The patient is admitted to the intensive care unit. An IV line is taken for infusions and medications. The first goal of treatment is to reduce mean arterial pressure by about 25% in the first 24-48 hours. However, hypertensive emergencies do not require hospitalization. The goal of treatment is to lower blood pressure within 24 hours that can be achieved on an outpatient basis. First, patients being treated for malignant hypertension are instructed to stay calm until stable. Once stable, all patients with malignant hypertension should eat a salt-restricted diet and focus on a weight-loss diet. Activity is limited to rest until the patient stabilizes. Once the blood pressure is checked, the patient should be able to resume normal activity as a walkable patient.
Hospitalization is essential until severe hypertension is controlled. Drugs given via the infusion line, such as nitroglycerin and nitroprusside, may lower blood pressure. An alternative for patients with renal failure is Fenoldpam i.v. Beta blockers can be given intravenously with esmolol or metoprolol. Labetalol is another popular alternative that allows for an easy transition from intravenous to oral (PO) administration. While enalapril, diltiazem, verapamil, and hydralazine are reserved for use in pregnant patients because they increase uterine reproduction, phentolamine is the best drug for the development of pheochromocytoma. After severe hypertension is controlled, regular oral antihypertensive medications can control your blood pressure. The medication may need to be adjusted from time to time as needed.
Things to remember:
Keep in mind that managing malignant hypertension is very important. Failure to do so can lead to life-threatening conditions such as heart failure, infarction, kidney failure and even blindness.