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Journal of the American Heart... Apr 2022Malignant hypertension is a hypertensive emergency, with rapid disease progression and poor prognosis. Although recognized as a separate entity more than a century ago,... (Review)
Review
Malignant hypertension is a hypertensive emergency, with rapid disease progression and poor prognosis. Although recognized as a separate entity more than a century ago, significant knowledge gaps remain about its pathogenesis and treatment. This narrative review summarizes current viewpoints, research gaps, and challenges with a view to pooling future efforts at improving treatment and prognosis.
Topics: Antihypertensive Agents; Disease Progression; Humans; Hypertension; Hypertension, Malignant; Prognosis
PubMed: 35289189
DOI: 10.1161/JAHA.121.023397 -
Journal of Human Hypertension Jan 2020
Topics: Acute Kidney Injury; Antihypertensive Agents; Blood Pressure Determination; Diagnosis, Differential; Early Medical Intervention; Emergency Medical Services; Humans; Hypertension, Malignant; Hypertensive Encephalopathy; Hypertensive Retinopathy; Multiple Organ Failure; Practice Guidelines as Topic; Prognosis
PubMed: 31636349
DOI: 10.1038/s41371-019-0267-y -
Expert Opinion on Pharmacotherapy Jul 2020According to current guidelines, malignant hypertension is one of the emergencies in hypertension. The definition requires the presence of bilateral retinal hemorrhages... (Review)
Review
INTRODUCTION
According to current guidelines, malignant hypertension is one of the emergencies in hypertension. The definition requires the presence of bilateral retinal hemorrhages or exudates, with or without papilledema, acute heart failure and acute deterioration in renal function in severe hypertension. Patients with malignant hypertension are characterized by pronounced target organ damage, including structural and functional cardiac abnormalities and renal insufficiency.
AREAS COVERED
Knowledge of the available treatment options is extremely important as we know that we only have a limited time to reduce blood pressure. There are only four drugs dedicated to immediate blood pressure lowering in patients with malignant hypertension, including 'first-line' and alternative drugs. Our review aims to discuss all those drugs and gives practical suggestions on how to properly use them.
EXPERT COMMENTARY
The decision of which drug to use depends on numerous factors including the clinical indications, pharmacokinetics, toxicity and drug interactions. Furthermore, frequently, more than one of the recommended drugs is required for the successful lowering of the patient's blood pressure.
Topics: Antihypertensive Agents; Humans; Hypertension, Malignant
PubMed: 32100590
DOI: 10.1080/14656566.2020.1732923 -
American Journal of Hypertension Jun 2017Malignant or accelerated hypertension is the most severe form of hypertension, defined clinically by very high blood pressure (diastolic above 130 mm Hg) accompanied by... (Review)
Review
Malignant or accelerated hypertension is the most severe form of hypertension, defined clinically by very high blood pressure (diastolic above 130 mm Hg) accompanied by bilateral retinal hemorrhages and/or exudates, with or without papilledema. The aim of this review is to discuss if malignant hypertension still poses a clinically relevant entity and to highlight the diagnostic challenges of this form of hypertension. The substantial improvement in prognosis in patients with malignant hypertension over the last decades is well documented, but there is no strong evidence to suggest a significant change in its incidence. In fact, with the growing population and improving life expectancy, malignant hypertension is likely to become even more prevalent worldwide, especially in the developing countries with less advanced health care services. Despite simple diagnostic criteria of malignant hypertension, the diagnoses may be difficult in many patients. Malignant hypertension patients often have the diagnosis established only when the target organ damage occur. Furthermore, retrospective diagnosis is problematic, as malignant hypertensive retinopathy gradually resolves over a relatively short period of time, while persistent target organ damage will, however, lead to the development of complications and much poorer prognosis than in nonmalignant hypertension patients. Certainly, malignant hypertension still poses a clinically relevant and challenging form of hypertension and its possibility should be always considered during the assessment of patients with poorly controlled hypertension.
Topics: Antihypertensive Agents; Blood Pressure; Disease Progression; Drug Resistance; Humans; Hypertension, Malignant; Predictive Value of Tests; Prognosis; Risk Factors; Severity of Illness Index; Terminology as Topic
PubMed: 28200072
DOI: 10.1093/ajh/hpx008 -
Journal of Human Hypertension Oct 2023Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice. Initiating... (Review)
Review
Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice. Initiating anti-hypertensive therapy and setting BP goal in acute settings requires important considerations which differ slightly across various diagnoses and clinical contexts. This position paper by British and Irish Hypertension Society, aims to provide clinicians a framework for diagnosing, evaluating, and managing patients with hypertensive crisis, based on the critical appraisal of available evidence and expert opinion.
Topics: Humans; Antihypertensive Agents; Hypertension; Hypertensive Encephalopathy; Hypertension, Malignant; Emergencies
PubMed: 36418425
DOI: 10.1038/s41371-022-00776-9 -
Presse Medicale (Paris, France : 1983) Dec 2019Malignant hypertension has not disappeared, it has been forgotten. Its incidence is increasing again. It considerably worsens the prognosis of young patients (35 to 55... (Review)
Review
Malignant hypertension has not disappeared, it has been forgotten. Its incidence is increasing again. It considerably worsens the prognosis of young patients (35 to 55 years old on average). There might be susceptibility factors, several hypotheses are under study. New diagnostic criteria and therapeutic options have been proposed and will have to be validated. Faced with these important challenges for patients, the first prospective multicentric register on this pathology will be set up in France in September 2019.
Topics: Diagnostic Techniques, Cardiovascular; Disease Susceptibility; France; Humans; Hypertension, Malignant; Incidence; Prognosis; Registries
PubMed: 31471092
DOI: 10.1016/j.lpm.2019.07.007 -
Journal of Hypertension Nov 2020: Malignant hypertension (MHT) still remains a severe condition that requires early recognition and treatment. Over the years, the prevention and treatment of MHT have... (Review)
Review
: Malignant hypertension (MHT) still remains a severe condition that requires early recognition and treatment. Over the years, the prevention and treatment of MHT have significantly advanced through the introduction of modern antihypertensive agents. However, in the absence of robust clinical trials, there remain no formal guidelines on the treatment of MHT. This review summarizes the historical background and pathophysiological evidence of MHT, which has led to common practices in its pharmacological management but can also introduce challenges. The current consensus for treatment involves early intravenous infusion of antihypertensive agents, but oral blockers of the renin-angiotensin system may improve the management of MHT, and it offers a suitable treatment option in low-income countries where the condition remains relatively prevalent.
Topics: Antihypertensive Agents; Humans; Hypertension, Malignant; Renin-Angiotensin System
PubMed: 32649635
DOI: 10.1097/HJH.0000000000002547 -
Internal Medicine (Tokyo, Japan) Sep 2023Malignant hypertension triggers incremental renin activity, whereas primary aldosteronism suppresses such activity. We encountered a patient with malignant hypertension...
Malignant hypertension triggers incremental renin activity, whereas primary aldosteronism suppresses such activity. We encountered a patient with malignant hypertension refractory to multiple anti-hypertensive agents. Repeated neurohormonal assessments, instead of a single one, eventually uncovered trends in an incremental aldosterone concentration, ranging from 221 up to 468 pg/mL, with a decline in the renin activity from 2.3 to <0.2 ng/mL/h. Adrenal venous sampling confirmed bilateral aldosterone secretion. Following the diagnosis of bilateral primary aldosteronism, we initiated a mineralocorticoid receptor antagonist, which improved his blood pressure. Repeated neurohormonal assessments are encouraged to correctly diagnose underlying primary aldosteronism with malignant hypertension.
Topics: Humans; Aldosterone; Hypertension, Malignant; Hyperaldosteronism; Renin; Mineralocorticoid Receptor Antagonists; Hypertension
PubMed: 36725041
DOI: 10.2169/internalmedicine.1098-22 -
Journal of Hypertension Oct 1991
Topics: Antihypertensive Agents; Humans; Hypertension, Malignant; Kidney Diseases
PubMed: 1658131
DOI: No ID Found -
Canadian Journal of Ophthalmology.... Aug 2023
Topics: Humans; Hypertension, Malignant; Central Serous Chorioretinopathy; Choroid Diseases; Fluorescein Angiography; Tomography, Optical Coherence
PubMed: 36481184
DOI: 10.1016/j.jcjo.2022.11.009