What Is Malignant Hypertension?

Malignant hypertension is also called aggressive hypertension, which is rare and more common in young adults. It can be exacerbated by slow-onset hypertension, or onset is rapid-onset hypertension. Clinically, the onset is rapid, progress is rapid, and blood pressure rises significantly, often exceeding 230 / 130mmHg. The characteristic lesions of malignant hypertension are arteriolar fibroid necrosis and necrotizing arteritis. Malignant hypertension is now called hypertensive emergency, and progressive hypertension is called hypertension subacute. Most patients died of uremia, severe kidney damage, cerebral hemorrhage, or heart failure.

Basic Information

nickname

Radical hypertension

English name

malignant hypertension

Visiting department

cardiology

Multiple groups

Young adults

Common causes

Improper diet and medication, obesity, mental factors, lack of exercise, pathological factors

Common symptoms

Suddenly increased blood pressure, systolic and diastolic blood pressure increased

Contagious

no

Causes of Malignant Hypertension

1. Improper diet and medication

Some people with hypertension are caused by improper diet. That is, after suffering from hypertension, do not pay attention to diet control, such as tobacco, alcohol, sugar, fatty meat, animal viscera, etc. are not taboo, aggravating arteriosclerosis, affecting vascular elasticity, leading to vasospasm, which can make blood pressure high and difficult. , Taking antihypertensive drugs is not effective. Single medication, neglecting the comprehensive treatment of drugs, is often the reason for the long-term treatment of hypertension.

2. Obesity

For obese hypertension, the degree of obesity is often in a balanced relationship with elevated blood pressure. If such hypertension patients rely solely on antihypertensive medications without losing weight, the blood pressure drop is often unsatisfactory. In addition to treatment, we should also pay attention to weight loss.

3. Mental factors

Elevated blood pressure is closely related to poor mental state, because emotional instability, sympathetic nerves are in tension, the secretion of catecholamines in the body is increased, blood vessels are in a constricted state, and blood pressure is not cured for a long time. Therefore, patients with hypertension should pay attention to themselves Reconcile, maintain a good mood, and overcome irritability.

4. Lack of exercise

Some hypertensive patients do not like activities, exercise too little, eat and sleep, and sleep and eat, relying solely on drug antihypertensive treatment, blood pressure often does not fall, so hypertensive patients should strengthen physical exercise. Physical activity can not only lower blood pressure, but also remove fat and lose weight, adjust psychological balance and improve mental stress.

5. Pathological factors

(1) 1% to 5% of essential hypertension can develop into aggressive (malignant) hypertension. Secondary hypertension is prone to develop this type of disease: renal artery stenosis, acute glomerulonephritis, pheochromocytoma, Cushing's syndrome, toxemia of pregnancy, and so on.

(2) Causes: Extreme fatigue, cold irritation, excessive nerve tension, and secretion disorders during menopause promote this type of hypertension.

Clinical manifestations of malignant hypertension

More common in young and middle-aged people, blood pressure suddenly increases significantly, systolic blood pressure and diastolic blood pressure increase, often lasting above 26.6 / 17.3kPa (200 / 130mmHg), the disease progresses rapidly, severe headache can occur, often accompanied by nausea and vomiting, Dizziness, tinnitus, etc., rapid vision loss, fundus hemorrhage, exudation or disc edema, sharp decline in renal function, persistent proteinuria, hematuria and cast urine, azotemia or uremia, heart failure can occur in a short period of time, Manifestations include palpitation, shortness of breath, and dyspnea. This type of hypertension is also prone to hypertensive encephalopathy, which is associated with a significant increase in blood pressure.

Malignant hypertension test

Urine routine

Persistent proteinuria, hematuria, and cast urine.

2. Renal function test

Serum creatinine continued to increase, urea nitrogen increased; CO ₂ CP decreased.

3. Blood potassium

Increased serum potassium levels indicate a poor prognosis.

4. Fundus

Retinal hemorrhage, exudation, and optic disc edema; those with KW fundus grade of to often have poor prognosis.

5. Blood pressure monitoring

It usually lasts at 26.6 / 17.3kpa (above 200 / 130mmHg).

Diagnosis of malignant hypertension

1. More common in young people.

2. Sudden headaches, dizziness, blurred vision, palpitations, shortness of breath, and weight loss.

3. Often manifestations of heart and kidney dysfunction.

4. Arterial diastolic blood pressure often exceeds 130 mmHg.

5. Fundus examination often has bleeding, exudation and optic disc edema. If caused by secondary hypertension, there are still corresponding clinical manifestations. Critical patients may have diffuse intravascular coagulation and microangiopathic hemolytic anemia.

The diagnosis of hypertension depends on the correct measurement of blood pressure. Indirect methods are usually used to measure blood pressure at the site of the upper brachial artery. Mercury (or electronic) sphygmomanometers or ambulatory blood pressure monitoring can be used. At present, the mercury column sphygmomanometer measurement under the standard method is still used as the standard method for the diagnosis of hypertension.

Differential diagnosis of malignant hypertension

1. Left heart failure caused by other reasons

Early blood pressure may be high, but DBP will never reach 140mmHg level, and there is no corresponding fundus change.

2. Uremia caused by any reason

Renal, pre-renal or post-renal lesions usually precede hypertension.

3. Brain tumor

Even the appearance of hypertension is mild, and optic disc edema is generally limited to one side.

4. Other

Such as head trauma to identify.

Malignant hypertension complications

Easily complicated by hypertensive encephalopathy, hypertension crisis, acute left heart failure and renal insufficiency.

Malignant hypertension treatment

Step-down principle

Diastolic blood pressure should be quickly reduced to a safe level (100-110mmHg). It should not be too low. Blood pressure should be suddenly reduced to too low a level. On the contrary, insufficient blood supply to important organs will lead to deterioration of heart, brain, and kidney functions. Shock may also occur Danger.

2. Antihypertensive drugs

Should choose drugs that inhibit renin, but do not affect or can increase renal blood flow. (Sodium nitroprusside: direct dilation of both arteries and veins; labelol: alpha and beta adrenergic blockers; hydralazine: direct expansion of peripheral arterioles; captopril: angiotensin conversion Enzyme inhibitors; Furosemide: a potent diuretic, which lowers blood pressure by reducing plasma volume and cardiac output; phentolamine: an alpha-blocker; calcium antagonists: optional nifedipine Or verapamil; guanethidine and its derivatives or other adrenergic blocking drugs can reduce renal blood flow, it should not be used.) Those who are not satisfied with a single dose of antihypertensive should be combined with drugs, but be careful not to use them at the same time The same side effects of the drug to avoid serious adverse reactions.

3. Etiology treatment

Most malignant hypertension (MHPT) is caused by parenchymal renal disease, renal vascular hypertension, drugs, etc. Therefore, after diagnosing MHPT, while actively controlling blood pressure, efforts should be made to find these secondary factors. And strive to remove or treat reversible causes. If the MHPT caused by renal artery stenosis is confirmed, the blood pressure and renal function of some patients can be satisfactorily controlled after percutaneous renal artery plasty (PTRA) or surgical treatment. After stopping the corresponding drugs, blood pressure can gradually return to normal.

Prognosis of malignant hypertension

The prognosis of aggressive (malignant) hypertension is relatively slow. Patients with acute hypertension are worse than critically ill with hypertensive encephalopathy, but without timely treatment, the one-year survival rate is only 10% to 20%, and most die within 6 months. If active and effective treatment can be taken, the 5-year survival rate is expected to reach 20% to 50%. Factors affecting prognosis are:

Degree of impaired renal function

The lighter have the possibility of long-term survival. When urea nitrogen in the blood reaches above 21.42 mmol / L, the prognosis is poor.

2. Blood pressure level

Those with systolic blood pressure above 24.7kPa (150mmHg) have poor prognosis.

3.KW fundus grading degree

The prognosis of patients with grade III or IV is poor.

4. Blood potassium levels

A marked increase in serum potassium concentration is an objective biochemical indicator of poor prognosis.