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The New Zealand Medical Journal Aug 2013The Waitemata Hypertension Clinic Database 2009-2012 (Auckland, New Zealand) was searched for patients meeting the definition of Malignant Hypertension. Eighteen of 565...
The Waitemata Hypertension Clinic Database 2009-2012 (Auckland, New Zealand) was searched for patients meeting the definition of Malignant Hypertension. Eighteen of 565 patients met the criteria. All patients had essential hypertension which was either undiagnosed, untreated or undertreated. Most cases responded satisfactorily to standard drug therapy, but a number were left with significant chronic kidney disease. Malignant hypertension is a life-threatening disease which should be entirely preventable with regular blood pressure checks in primary care.
Topics: Adult; Aged; Aged, 80 and over; Algorithms; Antihypertensive Agents; Blood Pressure Determination; Disease Progression; Emergencies; Female; Humans; Hypertension, Malignant; Kidney Failure, Chronic; Male; Middle Aged; New Zealand; Practice Guidelines as Topic
PubMed: 24126748
DOI: No ID Found -
Malignant hypertension: diagnosis, treatment and prognosis with experience from the Bordeaux cohort.Journal of Hypertension Feb 2019Malignant hypertension, the most severe form of hypertension, is defined by high blood pressure and acute ischemic organ damage. It has a worse prognosis than other...
BACKGROUND
Malignant hypertension, the most severe form of hypertension, is defined by high blood pressure and acute ischemic organ damage. It has a worse prognosis than other forms of hypertension, especially in black patients. New tools to assess organ damage, especially that of the heart and brain, are now available and may contribute to a better evaluation of these patients. This report improves knowledge of the characteristics of involved organs to facilitate diagnosis and to evaluate the effectiveness of our treatment protocol.
METHOD
The Bordeaux registry, started in 1995, recruited 168 patients. In addition to evaluations of their eyes and kidneys, these patients had a systematic evaluation of their hearts with ECG and echocardiography and, since 2007, a systematic brain MRI. Blood pressure was lowered with a protocol based on blockers of the renin-angiotensin system started at a very low-dose with forced titration over 48 h. Only an oral route was used for antihypertensive medication.
RESULTS
Systematic MRIs found significant brain damage in 93% of patients. Heart involvement was highly prevalent: 82% had left ventricular mass more than 60 g/m, and 56% had systolic dysfunction (estimated by global longitudinal strain). Renal involvement and thrombotic microangiopathy were respectively present in 55 and 15% of patients. Median follow-up was 48 months. Renal survival at 5 years was 90.8%, similar to other studies.
CONCLUSION
Malignant hypertension is a systemic disease causing severe damage to the brain, heart, kidneys and eyes, even in absence of symptoms. Renin-angiotensin system blockers seem to be the cornerstone of treatment.
Topics: Adult; Aged; Antihypertensive Agents; Blood Pressure; Brain; Cohort Studies; Echocardiography; Female; Humans; Hypertension, Malignant; Kidney; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Organ Failure; Prognosis; Registries; Renin-Angiotensin System
PubMed: 30160657
DOI: 10.1097/HJH.0000000000001913 -
The Journal of Emergency Medicine Jan 2013
Topics: Adolescent; Female; Fundus Oculi; Humans; Hypertension, Malignant; Papilledema; Photography
PubMed: 21820265
DOI: 10.1016/j.jemermed.2011.05.042 -
Indian Journal of Ophthalmology Dec 2022
Topics: Child; Humans; Hypertension, Malignant; Family
PubMed: 36453369
DOI: 10.4103/ijo.IJO_979_22 -
The American Journal of Case Reports Feb 2022BACKGROUND Malignant hypertension (MHT), one of the severest forms of hypertension, can have deleterious effects on various organs, such as renal failure, retinopathy,...
BACKGROUND Malignant hypertension (MHT), one of the severest forms of hypertension, can have deleterious effects on various organs, such as renal failure, retinopathy, and encephalopathy. These types of organ damage are common complications of MHT, but in several previous cases, damage to other organs, such as the gastrointestinal tract or pancreas, resulting from small vessel lesions, has also been reported, and these cases have had severe clinical outcomes and a poor prognosis. CASE REPORT A 32-year-old male patient with untreated hypertension of a 5-year duration presented with breathlessness and edema. His blood pressure was 220/144 mmHg, and he had renal dysfunction, congestive heart failure, and hypertensive retinopathy. He immediately received treatment, including antihypertensive agents and intermittent hemodialysis, but experienced epigastric pain for several days. A cystic lesion appeared in the pancreatic head, and his serum pancreatic enzymes were elevated. Based on these findings, acute pancreatitis with a cystic lesion was diagnosed. He first received fluid management, pain control, and parenteral nutrition but experienced 2 relapses. Finally, he received transpapillary endoscopic drainage for the cystic lesion with suspected walled-off necrosis. Thereafter, his symptoms improved. CONCLUSIONS The present case of MHT is the first to demonstrate acute necrotizing pancreatitis and it illustrates the difficulty of treatment. Therefore, if a patient with MHT presents with abdominal pain, a thorough workup, including contrast-enhanced computed tomography, should be performed to rule out significant organ involvement.
Topics: Acute Disease; Adult; Humans; Hypertension, Malignant; Male; Pancreas; Pancreatitis, Acute Necrotizing
PubMed: 35221328
DOI: 10.12659/AJCR.935271 -
Nihon Rinsho. Japanese Journal of... Dec 2001
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Nihon Rinsho. Japanese Journal of... Jan 2000
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Ryoikibetsu Shokogun Shirizu 1996
Review
Topics: Antihypertensive Agents; Humans; Hypertension, Malignant; Prognosis
PubMed: 9047399
DOI: No ID Found -
Tropical Doctor Jan 2017Takayasu arteritis (TA) is a chronic inflammatory and obliterative disease of large vessels, which mainly affects the aorta and its major branches. TA can lead to renal... (Review)
Review
Takayasu arteritis (TA) is a chronic inflammatory and obliterative disease of large vessels, which mainly affects the aorta and its major branches. TA can lead to renal failure and renovascular hypertension in 60% of patients; it is rare in children aged <10 years and, more rarely, it presents with malignant hypertension in the paediatric age group. Here we present a case of 9-year-old boy with TA who presented with malignant hypertension and required surgical intervention to control the blood pressure. Subsequently, his medications were titrated using 24 h ambulatory blood pressure monitoring (ABPM) and is doing well on follow-up.
Topics: Antihypertensive Agents; Child; Humans; Hypertension, Malignant; Male; Nephrectomy; Rare Diseases; Takayasu Arteritis
PubMed: 27216226
DOI: 10.1177/0049475516648062 -
Internal Medicine (Tokyo, Japan) 2016A 49-year-old man with malignant hypertension, acute kidney injury and mental deterioration was referred to our hospital. We initially observed microangiopathic...
A 49-year-old man with malignant hypertension, acute kidney injury and mental deterioration was referred to our hospital. We initially observed microangiopathic hemolytic anemia, thrombocytopenia and kidney damage, indicating he had thrombotic microangiopathy (TMA). We considered TMA was caused by malignant hypertension and therefore did not start plasma therapy. The French TMA reference center reported that platelet counts and serum creatine levels have high values for predicting severe ADAMTS13 deficiency. The patient fully recovered from his illness after treatment with antihypertensive drugs and intermittent hemodialysis. This case might thus be useful to understand the proper differential diagnosis and treatment of TMA.
Topics: Antihypertensive Agents; Humans; Hypertension, Malignant; Male; Middle Aged; Purpura, Thrombotic Thrombocytopenic; Renal Dialysis; Thrombotic Microangiopathies
PubMed: 27523008
DOI: 10.2169/internalmedicine.55.6332