Malignant Hypertension

By on September 1, 2012 with No Comments

 When a person suffers a very high blood pressure that comes quickly and abruptly, this is referred to as malignant hypertension.  During this form of blood pressure, the lower readings which show diastolic pressure are high from the normal range. A patient with malignant hypertension will record a diastolic reading of 130 mmHg way above the normal reading of 80 mmHg. When measuring blood pressure, there are basically two readings. One is the upper or first reading, which measures the pressure of the arteries when the heart beats. This is called the systolic pressure.

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Similarly, the blood pressure reading is measured through a lower reading or the second reading and this is called diastolic. This reading shows the pressure of the arteries between heart beats. The ideal blood pressure reading is recorded at 120/80 mmHg. In this case, 120 is the reading for systolic pressure and 80 represents diastolic pressure. In malignant hypertension, the 80 mmHg reading for diastolic pressure climbs up to 130 mmHg.

What are the causes of malignant hypertension?

It is estimated that 1% of hypertensive patients and especially those with essential hypertension develop malignant hypertension. The exact reason why some people develop malignant hypertension while others do not is actually not known. This disorder affects both children and adults and is usually more common in young African-American men.

There are health conditions which are associated with this disorder such as collagen vascular disorders, kidney problems and toxemia of pregnancy. People who have had kidney failure are more likely to suffer the condition. Also people who suffer renal hypertension, which is caused by renal artery stenosis, are also more likely to suffer from malignant hypertension.

Pathophysiology of malignant hypertension

Vascular lesion, a fibrinoid necrosis of arterioles and the small artery vessels can cause organ damage. When red blood cells are damaged as they flow through the blood vessels, which are obstructed by disposition of fibrin, they result in a type of anemia called microangiopathic hemolytic. This condition is said to result into malignant hypertension.

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Similarly, the dilation of cerebral arteries as a result of breakthrough of normal autoregulation emanating from cerebral blood flow is also another pathologic explanation of the cause of the disorder. Cerebral blood flow is regulated by cerebral vasoconstriction whenever there is increased blood pressure.

Patients with hypertension have their blood flow at about 110-180 mmHg and this is caused by thickening of the arteriolar. If the pressure of the blood exceeds the upper limit that is sustained by autoregulation, this makes the arteriolar to dilate. This results to a condition known as hyperperfusion. It also leads to cerebral edema and these are termed as clinical manifestations of hypertensive encephalopathy.

Symptoms of Malignant Hypertension

Patients suffering from malignant hypertension experience blurred vision and also chest pain. A person may feel crushing or pressure in the chest. There is also change in the mental status of the patient and this may be characterized by anxiety, confusion, decreased alertness and reduced concentration.

In addition, a person with malignant hypertension experiences fatigue, restlessness and sleepiness coupled with lethargy. Other symptoms include cough headache, nausea, vomiting, numbness, reduced urine, seizure and shortness of breath. There is also general weakness of the arms, legs, and face as well as other body parts.

Treatment of Malignant Hypertension

Medication of this disorder is aimed at reducing the blood pressure. Some of the medications which are administered are such as diuretics, which help in removing fluid from the body. Diuretics help in reducing the volume of blood, which subsequently increases blood pressure. If there is evidence of damage of the heart, the doctor prescribes medication to help protect the cardiac.

When the severe high blood pressure has been contained, the doctor embarks on medication aimed at maintaining it at low level. The administration of medication may change to oral or mouth. Initially medication is given through a vein in order to reduce the pressure and as the condition subsides, the drugs may be taken through the mouth.

If the condition is treated right away, it can be controlled without causing any problem. However, if left untreated, it can progress fast and become life threatening. When a patient experiences accelerated hypertension as with the case of malignant hypertension, there is an immediate need for therapy in order to reduce the blood pressure and this should be done within minutes to hours.

Hypertension urgency needs to be distinguished from hypertension emergence in that the former is a severe elevated blood pressure, which may range from systolic of more than 220 mmHg or a diastolic pressure of more than 120 mmHg and usually there is no target organ damage. In the case of hypertensive emergency, it requires emergency reduction of blood pressure and contrary to this; the hypertensive urgency can actually result to more harm if there is sudden and rapid reduction of the pressure.

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