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Journal of Human Hypertension Mar 2000
Review
Topics: Emigration and Immigration; Humans; Hypertension, Malignant; Incidence; Prevalence; Prognosis; Recurrence; United Kingdom
PubMed: 10694828
DOI: 10.1038/sj.jhh.1000967 -
Tissue Antigens Aug 1983Thirty-two patients with malignant hypertension and terminal uremia and a group of 1263 healthy blood donors were studied regarding the incidence of different HLA...
Thirty-two patients with malignant hypertension and terminal uremia and a group of 1263 healthy blood donors were studied regarding the incidence of different HLA antigens. HLA-Bw35; Cw4 antigens were found to be significantly more frequent in the group of patients with malignant hypertension than in the group of healthy individuals. The frequency of HLA-Bw35 in a group of 60 non-uremic patients with biopsy-proven glomerulonephritis and without malignant hypertension was also studied and found equal to the group of healthy blood donors. There was no overrepresentation of IgA nephritis among the HLA-Bw35 positive patients with glomerulonephritis, but advanced vascular lesions were more common among these than among patients with other HLA antigens.
Topics: Glomerulonephritis; HLA Antigens; Humans; Hypertension, Malignant
PubMed: 6623451
DOI: 10.1111/j.1399-0039.1983.tb01182.x -
British Journal of Clinical Pharmacology Jan 1982
Topics: Adult; Antihypertensive Agents; Blood Pressure; Female; Follow-Up Studies; Humans; Hypertension, Malignant; Middle Aged
PubMed: 7066155
DOI: 10.1111/j.1365-2125.1982.tb01337.x -
BMC Nephrology Jul 2016Malignant hypertension is a condition characterized by severe hypertension and multi-organ ischemic complications. Albeit mortality and renal survival have improved with...
BACKGROUND
Malignant hypertension is a condition characterized by severe hypertension and multi-organ ischemic complications. Albeit mortality and renal survival have improved with antihypertensive therapy, progression to end-stage renal disease remains a significant cause of morbidity and mortality. The underlying cause of malignant hypertension, which can be primary or secondary hypertension, is often difficult to identify and this can substantially affect the treatment outcomes, as we report here.
CASE PRESENTATION
A 33-year-old woman presented with severe hypertension and acute renal failure. Initial evaluation demonstrated hyperreninemia with hyperaldosteronism and a possible renal artery stenosis at the contrast-enhanced CT scan. Although this data suggested the presence of a secondary form of hypertension, further exams excluded our first diagnosis of renal artery stenosis. Consequently, the patient did not undergo renal angiography (and the contrast media infusion associated with it), but she continued to be medically treated to achieve a tight blood pressure control. Our conservative approach was successful to induce renal function recovery over 2 years of follow-up.
CONCLUSION
This case highlights the difficulty in differentiating between primary and secondary forms of malignant hypertension, particularly when the patient presents with acute renal failure. Clinicians should consider renal artery ultrasound as a first level diagnostic technique, given that the presentation of primary malignant hypertension can often mimic a renal artery stenosis. Secondly, adequate control of blood pressure is essential for kidney function recovery, although this may require a long time.
Topics: Acute Kidney Injury; Adult; Antihypertensive Agents; Essential Hypertension; Female; Humans; Hyperaldosteronism; Hypertension, Malignant; Renin
PubMed: 27389397
DOI: 10.1186/s12882-016-0291-x -
Journal of Stroke and Cerebrovascular... Nov 2012A 42-year-old woman presented with headache and nausea. Severe hypertension, renal dysfunction, thrombocytopenia, and anemia were present. A magnetic resonance imaging...
A 42-year-old woman presented with headache and nausea. Severe hypertension, renal dysfunction, thrombocytopenia, and anemia were present. A magnetic resonance imaging (MRI) scan of her head revealed widespread hyperintense lesions located in the brainstem and cerebellum on T2-weighted and fluid-attenuated inversion recovery imaging. Hypertensive encephalopathy was suspected, and antihypertensive therapy was started. A second MRI of the patient's head on day 12 of hospitalization revealed that the hyperintensities in the brainstem and cerebellum had almost disappeared, and that thrombocytopenia, anemia, and renal dysfunction had also gradually improved. Test results led to a diagnosis of malignant hypertension. This patient was regarded as suffering from malignant hypertension with reversible brainstem hypertensive encephalopathy (RBHE) and thrombotic microangiopathy (TMA). RBHE and TMA are known to occur as complications of malignant hypertension, but there has been no previous report of them occurring simultaneously. RBHE and TMA related to malignant hypertension are both conditions that can be improved by the rapid institution of antihypertensive therapy, and as such, early diagnosis and treatment are important. When treating patients with malignant hypertension, the possibility that it may be complicated by both RBHE and TMA must be kept in mind.
Topics: Adult; Antihypertensive Agents; Brain Stem; Cerebellum; Diffusion Magnetic Resonance Imaging; Female; Humans; Hypertension, Malignant; Hypertensive Encephalopathy; Magnetic Resonance Angiography; Thrombotic Microangiopathies; Time Factors; Treatment Outcome
PubMed: 22418002
DOI: 10.1016/j.jstrokecerebrovasdis.2012.02.005 -
Kidney International Feb 1995A genetic model of malignant phase hypertension in rats is described which closely parallels the natural history of untreated human malignant phase hypertension....
A genetic model of malignant phase hypertension in rats is described which closely parallels the natural history of untreated human malignant phase hypertension. Although the factors initiating transition from essential hypertension to the accelerated phase in humans remain unknown, we report the characteristics of a genetically determined and reproducible phenotype which was found to result from a cross between hypertensive transgenic Ren-2 rats and normotensive Sprague-Dawley (Edinburgh) rats. Male F1 hybrids developed malignant phase hypertension with a penetrance of 73.5% (95% confidence limits 65.7 to 81.3%) by 100 days of age. Phenotypic features included an accelerated rise in blood pressure, fibrinoid necrosis, activation of the renal renin-angiotensin system and microangiopathic hemolytic anemia. In an analytical cross no significant difference in blood pressure was observed between malignant phase and non-malignant phase animals prior to transition, implying that a factor in addition to hypertension appears necessary for inducing transition to the malignant phase phenotype. Segregation of the malignant phenotype suggested that susceptibility is determined by at most two genetic loci.
Topics: Alleles; Animals; Animals, Genetically Modified; Blood Pressure; Disease Models, Animal; Heterozygote; Hypertension, Malignant; Male; Phenotype; Rats; Rats, Sprague-Dawley
PubMed: 7723238
DOI: 10.1038/ki.1995.66 -
British Heart Journal May 1983We have studied electrocardiograms, chest radiographs, and digitised apex echocardiograms in 16 patients with malignant hypertension before and after up to six months of...
We have studied electrocardiograms, chest radiographs, and digitised apex echocardiograms in 16 patients with malignant hypertension before and after up to six months of antihypertensive treatment and compared them with those of eight patients with severe benign hypertension. Adequate blood pressure reduction was obtained in 14 with resolution of retinopathy, but one patient died and another had poor blood pressure control. Nine had electrocardiographic criteria of left ventricular hypertrophy which did not change with treatment and 10 had lateral ischaemia which resolved in seven. The malignant hypertensives were divided into seven with and nine without a previous hypertensive history. Both groups had normal echocardiographic cavity dimensions, but the former group tended to have hypertrophy (similar to that in benign hypertensives) and the latter did not. After adequate reduction of blood pressure, no change in wall and septal thickness occurred (except in one patient with poor blood pressure control). At entry, malignant hypertensives showed delayed mitral valve opening with significant cavity dimension increase during prolonged isovolumic relaxation, reduced peak rate, and prolonged duration of cavity dimension increase and cavity shape change (inward wall motion) during the upstroke of the apexcardiogram which showed a tall "a" wave. After reduction of blood pressure, though the delay in mitral valve opening persisted, the timing of A2 returned towards normal and the dimension change during the upstroke of the apexcardiogram and the relative height of the "a" wave were reduced but remained significantly different from normal. Some patients without a previous hypertensive history may develop a malignant phase without left ventricular hypertrophy on the electrocardiogram or echocardiogram. They maintain their pump function even with radiological pulmonary oedema, have incoordinate relaxation and contraction, and have abnormal filling. Similar functional abnormalities were found in malignant hypertensives with hypertrophy. Treatment to reduce blood pressure reduces incoordinate contraction, but impaired diastolic function persists as in benign hypertension, suggesting that these abnormalities are the result of altered myocardial properties that may occur without hypertrophy.
Topics: Adult; Blood Pressure; Echocardiography; Female; Heart; Humans; Hypertension, Malignant; Male; Middle Aged; Mitral Valve; Myocardial Contraction; Myocardium
PubMed: 6838734
DOI: 10.1136/hrt.49.5.477 -
Annals of Internal Medicine Nov 1980
Topics: Adult; Blood Pressure; Female; Humans; Hypertension, Malignant; Kidney; Minoxidil; Pyrimidines; Uremia
PubMed: 7212489
DOI: 10.7326/0003-4819-93-5-769 -
Kidney International Aug 1984
Topics: Adult; Brazil; Captopril; Drug Therapy, Combination; Female; Furosemide; Humans; Hypertension, Malignant; Renin; Vascular Diseases
PubMed: 6389957
DOI: 10.1038/ki.1984.158 -
American Journal of Hypertension Feb 2021Malignant hypertension is macrovascular and microvascular endothelial injury responsible for multiple organ damage. Considering the anatomical and functional homologies...
BACKGROUND
Malignant hypertension is macrovascular and microvascular endothelial injury responsible for multiple organ damage. Considering the anatomical and functional homologies between the posterior pole of the eye and the kidney, ophthalmological explorations may inform clinicians on the mechanisms underpinning concurrent kidney injury in this condition. More specifically, we investigated whether the wall-to-lumen ratio (WLR) of retinal arterioles measured by adaptive optics ophthalmoscopy could be correlated to WLR of kidney arterioles as determined by pathology. We sought to estimate the incidence of retinal arteriole occlusion a supposedly uncommon complication of malignant hypertension.
METHODS
All patients hospitalized in our renal Intensive Care Unit for malignant hypertension between 2016 and 2019 were referred to ophthalmological examinations.
RESULTS
Twenty-seven patients were included. Median retinal WLR was 0.39 [0.31-0.47] and was correlated with initial systolic (r = 0.56, P = 0.003) and mean blood pressure (r = 0.46, P = 0.02) upon admission. The retinal WLR was not correlated to renal pathological findings, as assessed by juxtaglomerular WLR (r = 0.38, P = 0.2), ratio of glomerulosclerosis (r = -0.39, P = 0.2), or tubulointerstitial fibrosis (r = -0.45, P = 0.08). Retinal WLR was not associated with neurological or cardiovascular end-organ damage. Branch retinal artery occlusion was detected in 18.5% of patients and exudative retinal detachment (ERD) in 29.6% of patients, without any significant correlation with canonical signs of retinal hypertension including optic disc swelling.
CONCLUSIONS
In the setting of malignant hypertension, we failed to demonstrate a significant relationship between WLR and other meaningful end-organ injuries. However, branch retinal artery occlusion and ERD may have been hitherto underestimated.
Topics: Arterioles; Blood Pressure Determination; Correlation of Data; Female; France; Humans; Hypertension, Malignant; Incidence; Juxtaglomerular Apparatus; Kidney Diseases; Male; Middle Aged; Ophthalmoscopy; Retina; Retinal Artery Occlusion; Retinal Detachment; Retinal Vessels
PubMed: 32840289
DOI: 10.1093/ajh/hpaa138