Causes of malignant hypertension and methods of its elimination. Malignant arterial hypertension Signs of malignant hypertension are

I10 Essential [primary] hypertension

Epidemiology

Malignant arterial hypertension, as a form of arterial hypertension, is not often observed (up to 1% of patients). Currently, primary malignant hypertension is extremely rare (0.15-0.20% among all persons with essential hypertension). Mostly males under the age of 40 get sick, after 60 years, the incidence sharply decreases, and by the age of 70, the disease is extremely rare.

Causes of malignant arterial hypertension

Arterial hypertension of any nature (hypertension or symptomatic hypertension) can acquire features of malignancy in the process of development. The most common causes of malignant arterial hypertension are:

parenchymal kidney disease (rapidly progressive glomerulonephritis);
end-stage renal failure;
arterial hypertension in smokers.

In some cases, malignant arterial hypertension can develop in endocrine pathology (pheochromocytoma, Conn's syndrome, renin-secreting tumors), in women in late pregnancy and / or in the early postpartum period. This evolution is predominantly observed in untreated or inadequately treated patients.

In contrast to other forms of arterial hypertension, in which there is a gradual elasto-fibroplastic restructuring of arterioles, the cause of the development of malignant arterial hypertension is acute changes in renal arterioles with the development of fibrinoid necrosis. In malignant arterial hypertension, renal arterioles are often completely obliterated as a result of intimal proliferation, smooth muscle cell hyperplasia and fibrin deposition in the necrotic vascular wall. These changes lead to disruption of local autoregulation of blood flow and the development of total ischemia. In turn, renal ischemia leads to the development of renal failure.

As a factor responsible for acute vascular changes in malignant arterial hypertension, hormonal stress is considered, leading to uncontrolled synthesis of vasoconstrictor hormones and manifested by:

a sharp increase in blood vasoconstrictor hormones (hormones of the renin-angiotensin-aldosterone system, endothelial pressor hormones, vasopressin, catecholamines, pressor fractions of prostaglandins, and so on);
water-electrolyte disturbances with the development of hyponatremia, hypovolemia and often hypokalemia;
the development of microangiopathies.

Malignant arterial hypertension is often accompanied by damage to erythrocytes by fibrin filaments with the development of microangiopathic hemolytic anemia. At the same time, morphological changes in blood vessels in malignant arterial hypertension are potentially reversible with adequate and constant antihypertensive treatment.

Symptoms of malignant arterial hypertension

Malignant arterial hypertension is characterized by the sudden onset and rapid progression of all symptoms of the disease. The appearance of patients is characteristic: the skin is pale, with an earthy tinge. Symptoms of malignant arterial hypertension often occur, such as dyspeptic complaints, rapid weight loss up to cachexia. Blood pressure is steadily maintained at a very high level (200-300 / 120-140 mm Hg). Reveal a tendency to increase in pulse pressure; the circadian rhythm of blood pressure changes (periods of nighttime decrease in blood pressure disappear). Hypertensive encephalopathy, transient cerebrovascular accidents often develop with an appropriate clinic.

Heart failure usually occurs as left ventricular failure, with frequent development of pulmonary edema. Echocardiographic examination reveals signs of left ventricular hypertrophy and dilatation.

An important clinical and diagnostic criterion for malignant arterial hypertension is the fundus changes manifested by hemorrhages, exudates, and edema of the optic nerve head. A sudden loss of vision in one or both eyes, which develops as a result of hemorrhages or other changes in the retina, is characteristic.

Forms

At the present stage, malignant arterial hypertension is considered as a form of essential hypertension or symptomatic arterial hypertension, an independent nosological form of the disease, first described by Folgard and Far in 1914 and studied in detail by E.M. Tareev in the middle of the XX century.

Diagnostics of the malignant arterial hypertension

Laboratory diagnostics of malignant arterial hypertension

Kidney damage is characterized by the development of proteinuria (nephrotic syndrome occurs rarely), a decrease in the relative density of urine, changes in urinary sediment (often erythrocyturia). With a decrease in blood pressure, the severity of urinary syndrome decreases. Oliguria, increasing azotemia, anemia reflect the early and rapid development of end-stage renal failure, although renal scarring is detected in only a part of patients. Often, with malignant arterial hypertension, acute renal failure develops.

Diagnosis of malignant arterial hypertension involves the identification of anemia, often with elements of hemolysis, fragmentation of erythrocytes and reticulocytosis; coagulopathy of the type of disseminated vascular coagulation with the development of thrombocytopenia, the appearance of fibrin degradation products in the blood and urine; ESR is often increased. In most patients, high plasma renin activity and increased aldosterone content are found.

Treatment of malignant arterial hypertension

Malignant arterial hypertension is considered a medical emergency. Initial treatment of malignant arterial hypertension is a decrease in blood pressure within 2 days by 1/3 of the initial level, while the level of systolic blood pressure should not be reduced below 170 mm Hg, and diastolic blood pressure - below 95-110 mm Hg For this purpose, fast-acting antihypertensive drugs administered intravenously are used for several days. Further lowering of blood pressure must be carried out slowly (over the next weeks) and carefully to avoid hypoperfusion of organs and further deterioration of their functions.

Treatment of malignant arterial hypertension: drugs for intravenous administration

Several drugs can be used for intravenous administration.

Sodium nitroprusside is administered for a long time (3-6 days) by drip at a rate of 0.2-8 μg / kg per minute with dose titration every 5 minutes. Constant and careful monitoring of blood pressure and the rate of administration of the drug is required.

Nitroglycerin (administered at a rate of 5-200 mcg / min) is the drug of choice for the treatment of arterial hypertension in conditions of myocardial infarction, unstable angina pectoris, with severe coronary and left ventricular failure.

Diazoxide is administered at 50-150 mg intravenously, the total dose should not exceed 600 mg / day. The action of the drug lasts for 4-12 hours. The drug should not be used if malignant arterial hypertension is complicated by myocardial infarction or dissecting aortic aneurysm.

Perhaps intravenous use of the ACE inhibitor enalapril at a dose of 0.625-1.25 mg every 6 hours The dose is halved when the drug is combined with a diuretic or in severe renal failure. The drug is indicated for symptoms of severe heart failure; it should not be used in patients with bilateral renal artery stenosis.

Labetolol, which has both alpha and beta adrenergic blocking activity, is administered as a bolus of 20-40 mg every 20-30 minutes for 2-6 hours. The total dose of the drug should be 200-300 mg / day. During the administration, bronchospasm or orthostatic hypotension may develop.

Sometimes verapamil is effective with intravenous jet injection at a dose of 5-10 mg. As a natriuretic, furosemide is used orally or intravenously. Additionally, you can use plasmapheresis and ultrafiltration.

Treatment of malignant arterial hypertension: oral medications

If the specified intensive treatment of malignant arterial hypertension, carried out within 3-4 days, achieves the desired result, an attempt can be made to switch to treatment with oral medications, usually with the use of at least three antihypertensive drugs of different groups, adjusting the doses in order to further slowly lower the blood pressure.

When prescribing antihypertensive drugs, it is necessary to clearly establish the cause of the development of malignant arterial hypertension (renoparenchymal, renovascular, malignant arterial hypertension due to endocrine pathology, ischemic kidney disease, etc.), the state of renal functions, concomitant diseases, in order to take into account the advantages and disadvantages of each group of antihypertensives and determine the possibility of their combined use.

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The disease is characterized by very high blood pressure, as a result of which severe changes in the vascular walls occur. Most often, the disease leads to dangerous consequences and the development of various pathologies. This disease is very dangerous to human life, therefore, therapeutic measures should begin as soon as possible. Without treatment, malignant arterial hypertension is most often fatal.

In most cases, the disease occurs due to a malignant tumor of the adrenal glands, but there are other reasons for the development. Such as:

Kidney disease in severe form;
Adrenal pathology;
Renal artery stenosis;
Severe renal failure.

In addition, malignant arterial hypertension can be caused by the misuse of certain medications. Also, the disease can occur in people who abuse bad habits (alcohol, tobacco smoking, drugs).

When harmful substances enter the body, a sharp vasoconstriction occurs. This very often aggravates the course of hypertension and leads to the fact that it passes into a malignant stage.

Symptoms

Malignant arterial hypertension is always accompanied by a number of symptoms. The first thing that begins to bother the patient is headaches. They can be whining, pressing or shooting. Most often, the pain syndrome occurs in the early morning and intensifies by lunchtime. Localization of pain, usually in the occiput, but can also radiate to the parietal part.

Constant morning headache is a wake-up call for your body

In addition, the patient almost always has:

Sudden weight loss;
Significant deterioration in the condition;
Blanching of the skin;
Breathing problems, in particular shortness of breath;
Loss of visual acuity;
Decreased appetite
Apathy and increased anxiety;
A feeling of tightness in the chest;
Rapid heartbeat and / or increased heart rate.

Also, every third patient with malignant hypertension has a strong decrease in body temperature and / or cold extremities.

Note. In addition, this type of hypertension is accompanied by persistently high blood pressure and, in almost all cases, sleep disturbance. This is explained by the fact that an increase in blood pressure occurs most often at night, due to which the patient's condition deteriorates significantly. This is what leads to sleep problems.

Diagnostics

To make an accurate diagnosis, you will need to undergo a series of clinical examinations. Without them, it is impossible to determine the disease. In addition to the fact that at the initial stage the doctor collects complete information about the patient (existing diseases, present symptoms, etc.), procedures such as:

General analysis of blood and urine;
Control of daily blood pressure;
Ultrasound examination of the heart and thyroid gland;
Echocardiography;
Electrocardiography.

In addition to these diagnostic measures, a combined study (USDG) is prescribed. Using this method of examination, the doctor can assess the state of the patient's blood vessels and make an almost unmistakable diagnosis. Also, to determine the general condition of the patient, the therapist may prescribe a consultation and examination of other doctors - a cardiologist, ophthalmologist, endocrinologist and neuropathologist.

Treatment

Many diseases at the initial stage can be cured with the help of various decoctions and herbal infusions. This does not apply to malignant arterial hypertension. It can only be cured with pharmaceutical drugs.

Therapeutic measures, as with any other disease, are aimed at treating the disease that caused the pathology, relieving symptoms and improving the patient's condition. For these purposes, medicines, traditional medicine (as a supplement), diet therapy, as well as various preventive measures can be used.

Malignant arterial hypertension is a serious disease, therefore only a doctor will prescribe the necessary treatment

Drug therapy

The main group of medicines:

Diuretic drugs;
Vasodilators;
Beta-blockers;
Psychotropic and neurotropic medications;
Ganglion blockers;
Stimulants of a-adrenergic receptors;
Sympatholytics.

Any treatment is selected by a doctor. It will not be possible to combine drugs on your own, because each course of the disease is individual and there is no specific treatment regimen that would suit everyone. Therapy is selected depending on the cause of the disease, symptoms, age of the patient, and also based on the individual characteristics of the organism.

First of all, it is necessary to lower blood pressure by 20-25% of the already existing indicators, since constantly high pressure has a detrimental effect on vital organs. For these purposes, as a rule, three or four-component treatment is used. The drugs and the intake rate are determined for each patient individually, but most often therapy is prescribed according to the following schemes:

Diuretics (diuretics) in combination with calcium antagonists and beta-blockers.
ACE inhibitors supplemented with diuretics and calcium antagonists.
Beta blockers with calcium antagonists as well as ACE inhibitors.
Antagonists of A T1 receptors with diuretics and calcium channel blockers.
If malignant hypertension is supplemented by diabetes mellitus, then the most effective will be the administration of alpha-adrenergic receptor antagonists in combination with imidazoline receptor agonists and the mandatory inclusion of ACE inhibitors in the regimen.

Blood pressure must be lowered to normal levels, but gradually. A sharp decline is unacceptable, as this can only exacerbate the situation. After the pressure is normalized, the doctor prescribes complex drug therapy.

Important! Self-selection of schemes for lowering blood pressure is prohibited. This most often leads to aggravating consequences, including the death of the patient.

Principles of non-drug treatment

Along with medicines, a good supplement that enhances the therapeutic effect is:

Body weight control;
Quitting all bad habits;
The use of vitamin complexes;
Normalization of diet, rest and sleep;
Sports activities;
Limiting salt and fluid intake;
Eating food rich in vitamins and minerals.

In addition, constant monitoring of blood pressure and regular visits to the attending physician are required. This will help track the dynamics of treatment and determine its effectiveness. If the prescribed therapy does not bring the desired effect, the doctor will adjust the treatment and make new recommendations.

If the patient's condition is assessed as poor, then most often he is referred for inpatient treatment. In this case, the therapy will take place under the close supervision of a specialist.

Effects

Like any dangerous disease, malignant hypertension most often leaves any consequences. The most common ones are:

Ischemia;
Stroke;
Loss of vision;
Renal failure

In addition, the appearance of chronic anemia, hemorrhages and other, no less dangerous pathologies is possible.

Forecast

The disease belongs to the group of pathologies dangerous to human life. If malignant arterial hypertension is not treated, then in 100% of cases it is fatal. In the case of timely intervention of a specialist and on time the treatment started, the patient has an improvement already in the first month of treatment.

To achieve positive dynamics, you need to strictly follow the doctor's recommendations, and under no circumstances should you stop the course of treatment. Only in this case you can get a good result and improve your health as quickly as possible.

Prophylaxis

Any disease can be prevented by adhering to some preventive measures. The development of malignant hypertension can be avoided if:

To refuse from bad habits;
Eat healthy foods;
Monitor body weight and do not overeat;
Eliminate junk food (fried, spicy, salty, etc.) from the diet;
Avoid stress, which has a detrimental effect on the entire body;
Keep fit;
Do not cancel or correct the treatment of arterial hypertension on your own.

According to statistics, a person who does not treat malignant arterial hypertension dies within 4-6 months. It is important to remember this and not neglect your health. The course of treatment started on time will improve the quality of life and live long and happy years.

Timely treatment is always a guarantee of recovery, do not neglect your health!

An extreme increase in blood pressure (systolic more than 180 or diastolic more than 120, the medical term is "malignant arterial hypertension") is a severe form of arterial hypertension with an acute violation of one or more organs and systems (usually the central nervous, cardiovascular and / or kidney ). Officially, in addition to high pressure figures, this condition should present bleeding into the retina of both eyes and swelling of the optic nerve.

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Reasons for the appearance

Malignant arterial hypertension may appear de novo (in the absence of hypertension) or complicate the course of essential hypertension (hypertension itself) or secondary arterial hypertension. There are diseases that can be complicated by malignant hypertension:

Renal etiology(parenchymal lesions):

glomerulonephritis,
tubulointerstitial nephritis,
systemic diseases with kidney damage:

systemic sclerosis,
diabetes,
systemic lupus erythematosus,

congenital pathology:

renal aplasia.

Damage to the vessels of the kidneys:

atheroma,
fibromuscular dysplasia,
acute occlusion (blockage).

Endocrine diseases:

pheochromocytoma,
Connes syndrome
Cushing's syndrome.

Medicines and illegal drugs:

cocaine,
amphetamines,
monoamine oxidase inhibitors,
erythropoietin,
cyclosporine.

Tumors:

renal carcinoma,
Wilms tumor
lymphoma.

Preeclampsia / eclampsia.

Symptoms

The clinical manifestations of malignant hypertension reflect the consequences of the effect of high BP numbers on target organs. The extent of their damage, in turn, depends on the levels and rate of increase in blood pressure and the presence of concomitant diseases.

Blood pressure... The range of fluctuations in blood pressure is quite wide: diastolic blood pressure is from 100 to 180 mm Hg, systolic blood pressure is from 150 to 290 mm Hg. As a rule, but not always, the malignant course of hypertension is preceded by a stable phase (moderate increase in blood pressure in the absence of hypertensive crises).

Symptoms associated with organ damage. The main, but not always, sign of pathology is bleeding from tiny arteries located in the retina. They are a layer of intertwined nerves located at the back of the eyeball. The main task of the retina is to "catch" light streams, convert them into nerve impulses and send them through the optic nerve to the brain, where they are processed and formed into visual images. Therefore, the resulting bleeding in the retina leads to deterioration of vision.

Hypertensive retinal angiopathy

In addition to visual impairment in malignant hypertension, depending on which organs are affected, the following symptoms may appear:

chest pain (angina);
labored breathing;
dizziness;
numbness in the arms, legs;
Strong headache;
intermittent breathing

Sometimes cerebral edema may occur, which leads to the development of a dangerous condition -. Symptoms of this condition include:

complete loss of vision;
changes in mental status, up to a coma;
drowsiness;
headache that is growing;
nausea and vomiting.

Diagnostics

Diagnosis is based on the presence of high blood pressure numbers and signs of acute organ damage. In this situation, the doctor will usually perform the following manipulations:

urea and urea levels that rise when the kidneys are affected;
blood clotting indicators;
blood sugar levels;
general blood analysis;
sodium and potassium content;
the presence of blood, protein in the urine.

Other blood tests may be ordered, depending on the results of the above tests.

Of the instrumental research methods, the following are usually prescribed:

echocardiography;
electrocardiogram (ECG);
chest x-ray;
studies of the kidneys, which assess their blood supply.

Malignant hypertension, the symptoms and treatment of which are best known to the cardiologist, requires immediate medical attention. In the presence of pathology, an urgent decrease in blood pressure is required within two days. That is why the patient should not be "capricious", look for a super specialist, it is necessary to trust any doctor who "turned up at hand".

Treatment

Malignant arterial hypertension is a medical emergency requiring treatment in a hospital, often in an intensive care unit. After assessing the patient's general condition and symptoms, treatment begins with measures that are aimed at lowering blood pressure. Prior to this, antihypertensive drugs are usually injected intravenously. After the blood pressure stabilizes at lower numbers, they switch to oral medications.

Watch the video about arterial hypertension and its treatment:

If acute heart failure develops, hemodialysis (artificial kidney) is often used. In the event that the cause of malignant hypertension is established, therapeutic measures are taken to eliminate it. For example, in case of a tumor of the kidney or adrenal gland, surgical removal is performed, in case of damage to the vessels of the kidneys (occlusion, aplasia), the prosthetics of the "compromised" section of the artery is performed or it is expanded by installing a stent.

Complications

If blood pressure is not lowered in time, malignant hypertension can be fatal. The following are the most common complications of this condition:

rupture of the aorta,
acute heart failure
coma,
stroke,
acute renal failure.

Providing timely medical care for malignant hypertension can prevent the development of life-threatening complications.

The prognosis largely depends on the timeliness and effectiveness of antihypertensive treatment for malignant arterial hypertension. The mortality rate among patients who do not receive proper treatment is 80%. With adequate medical therapy, the five-year survival rate is greater than 90%.

Symptoms

Like any other disease, malignant hypertension has its own distinctive symptoms. Usually they make themselves felt after the pathological process passes the initial stage of development. This is because at the first stage he does not manifest himself in any way. After this, the patient's general condition worsens, which is caused by an increase in the signs of his illness. Headaches are the first to make themselves felt. They are felt in the area of the frontal part and the back of the head. The pains are especially severe in the morning hours.

The first symptom is morning headache.

With a sharp increase in blood pressure, the patient develops severe nausea, which is often accompanied by vomiting, seizures and even loss of consciousness. The following signs of malaise are also added to the general symptomatology:

Unreasonable weight loss;
Impaired concentration and memory;
Deterioration of vision, which sometimes ends in complete blindness;
Loss of appetite;
Decrease in body temperature;
Chest pain that worsens after physical activity.

A patient who suffers from malignant hypertension will have trouble sleeping. This is because at night his pressure rises somewhat. A person's face takes on a grayish tint. The development of hypertensive encephalopathy is not excluded.

Diagnostics

If the doctor notices symptoms of a malignant form of hypertension in his patient, he will send the person for examination. The results of the research passed will help him understand whether his guesses are correct or not.

An external examination of the body is required to detect changes in skin color, determine the patient's weight, and measure the pressure on the legs and arms.

You cannot do without the following diagnostic methods:

Blood test;
Electrocardiography;
UZDG;
Ultrasound of the thyroid gland and heart;
24-hour urine analysis;
Echocardiology;
Analysis of daily blood pressure.

If you suspect malignant arterial hypertension, you will have to visit a number of narrowly specialized doctors

You will definitely need to visit an ophthalmologist, neuropathologist, cardiologist, nephrologist and endocrinologist. Narrow-profile specialists can identify violations that need to be eliminated in order to normalize the condition of hypertensive patients.

Treatment

Malignant hypertension develops very quickly. Therefore, its treatment should be started from the first days of the manifestation of symptoms of the pathological process. Thanks to this, it will be possible to prevent serious complications due to which internal organs and systems suffer.

Treatment of malignant hypertension in most cases is based on eliminating its cause. For example, if the narrowing of the renal vessel was due to a tumor in the area of this organ, then it is required to first remove the neoplasm, as well as replace the affected area with a special prosthesis.

Drug therapy

If the symptoms of the disease have made themselves felt, you need to start treating hypertension with pharmacy medicines. This is an obligatory part of therapy, without which it is extremely unreasonable to count on recovery. It includes several drugs with similar effects. They are taken in conjunction with each other.

Therapy is not limited to prescribing only one drug

It is necessary to fight a malignant disease with the following groups of drugs:

Diuretics;
Beta-blockers;
Psychotropic and neurotropic;
Ganglion blockers;
Sympatholytics;
Peripheral vasodilators.

Before proceeding with the choice of medicines, it is necessary to study in detail the nature and degree of the increase in blood pressure. Kidney function, heart rate and the presence of diseases that are related to hypertension, regardless of whether it is benign or malignant, are assessed separately.

To achieve an improvement in well-being, it is necessary to reduce the pressure to a level no more than 25% of the current values. If by this time the patient does not have adverse reactions to drugs, and his internal organs continue to function normally, he can begin to lower blood pressure to natural values.

Doctors have repeatedly said that in patients with malignant hypertension affecting the brain and kidneys, there is a violation of autoregulation. Because of this, an incorrect decrease in blood pressure almost always leads to the development of complications that are dangerous to health and life.

Therapeutic therapy can include various regimens that consist of one or more components. It is worth noting that in the case of a malignant form of the disease, courses based on 1 or 2 drugs are unlikely to bring a positive result. It is for this reason that doctors immediately try to prescribe treatment for hypertensive patients with a therapeutic combination of 3 or 4 medications.

A 3-component treatment regimen is popular. In malignant hypertension, it may be as follows:

ACE inhibitors, supplemented with calcium antagonists and diuretics;
Diuretics combined with beta-blockers and calcium antagonists;
Antagonists of A T1 receptors together with diuretics and calcium channel blockers.
Beta blockers that are supplemented with calcium antagonists and ACE inhibitors.

When choosing a therapeutic course, attention is paid to the presence of signs of damage to the pathological process of target organs. If they are present, correction of the insufficiency that is observed in a particular organ is required. Also, the doctor should take into account the interaction with each other of all prescribed medications belonging to different groups.

If necessary, drug therapy will be supplemented with other therapeutic methods. For example, with obvious severe renal failure, hemodialysis or hemofiltration will be required. Another method of blood purification is often used, which is called hemosorption.

Serious kidney damage will require hemodialysis

If the patient has edema, it is proposed to carry out isolated ultrafiltration of blood plasma. If no improvement is noted as a result of such treatment, the patient is sent for kidney transplantation.

Only under the condition of an integrated approach to the treatment of malignant arterial hypertension can one expect an improvement in overall health.

Principles of non-drug treatment

Sometimes experts suggest that patients take up non-drug treatment. This is an additional therapy that should be carried out in parallel with the traditional one. It is based on a number of simple principles:

Bringing body weight back to normal;
Adequate intake of trace elements important for blood vessels, such as magnesium, calcium and potassium;
To give up smoking;
Limiting the consumption of animal fats;
Restriction in the use of alcoholic beverages or complete refusal from them;
Increased physical activity.

Once again, it is worth recalling that the decrease in high blood pressure, about which a person is warned by the symptoms characteristic of this condition, cannot be sharp and haphazard. This will severely disrupt the mechanisms of blood flow. Due to a sharp decrease in blood pressure, a person will face another unpleasant condition called hypoperfusion. For 1 hour, a decrease in blood pressure values is allowed by a maximum of 15% of the current indicator.

To prevent the occurrence of adverse consequences and complications, every hypertensive person who has a malignant form of the disease should visit his doctor on a quarterly basis. At the reception, he is obliged to check the patient's pressure, direct him to donate blood and undergo other studies (study of the eyeball, ECG). It will not hurt to re-examine it with other narrow-profile specialists, who can also trace the dynamics of changes in the development of the pathological process and its effect on the body.

If during the visit the doctor does not notice significant positive changes, he will be forced to recommend the patient to agree to inpatient treatment. This method is usually resorted to when it is impossible to lower blood pressure values using standard methods.

Stationary therapy always takes place under the close supervision of the attending physician. He must monitor the dosage of medicines, as well as find out the reaction of the patient's body to taking certain medications.

Effects

If a hypertensive person, whose disease has turned into a malignant form, does not begin to be treated, he risks facing a number of dangerous complications. Delayed hypertension can have the following consequences:

Stroke. It is the most frequent consequence of the disease, which can lead not only to disability, but also death;
Loss of vision. It occurs due to retinal detachment and multiple hemorrhages. Damage to the optic nerve leads to this outcome;
Violation of the blood supply to the kidneys. This is fraught with heart attack or necrosis for a person. Both conditions provoke the appearance of renal failure. Because of it, the body ceases to cleanse itself of toxins;
Cardiac ischemia. It occurs against the background of poor blood supply to the heart muscle.

The most common consequence of the pathology is stroke.

Doctors who are actively involved in scientific research are trying to come up with new treatment methods that reduce the likelihood of the development of pathological processes in patients with malignant hypertension. The currently existing therapeutic methods already allow hypertensive patients to live 5 or more years more with an unfavorable diagnosis. But it is worth remembering that in the absence of timely therapy it is naive to rely on such a result, since it is unlikely to be achieved.

If professional help is never provided to hypertensive patients with a malignant form of the disease, then he will hardly be able to save himself from complications such as renal and heart failure.

Forecast

Experts talk about disappointing statistics for people with malignant arterial hypertension. If they do not start treating a dangerous disease, then after 6 months they may die.

The prognosis of recovery is determined by modern treatment, which gives an antihypertensive effect. Only 20% of all patients manage to survive in the absence of adequate therapy for 1 year. If the patient turns to a specialist in a timely manner and responsibly fulfills all his recommendations, then in 90% of cases a favorable outcome is observed.

Prophylaxis

There are not many factors that affect blood pressure and can cause it to jump. Therefore, a person prone to such a disease should limit his interaction with them. Most often, the abuse of tobacco products, impaired blood clotting and an inappropriate diet leads to a dangerous diagnosis. Therefore, it is these moments that a patient should pay attention to, whose disease will easily develop into a malignant one in the presence of appropriate factors.

If a person can normalize nutrition and stop smoking, then he should carry out the prevention of blood clotting under the strict guidance of a competent specialist.

Hypertensive patients should make every effort to avoid the malignant form of hypertension. This is a guarantee of their long life.

Initial diagnostic tests for malignant hypertension include CBC and electrolyte (including calcium), blood urea, creatinine, glucose, coagulation profile, and urinalysis.

Other laboratory tests are prescribed only in accordance with the directions of therapy. These may include measurements of heart enzymes, urinary catecholamines, and thyroid-stimulating hormone.

Kidney function is assessed using urinalysis, complete chemistry profile, and CBC. Expected results include increased blood urea and creatinine levels, hyperphosphatemia, hyperkalemia or hypokalemia, impaired glucose metabolism, acidosis, hypernatremia, and confirmation of microangiopathic hemolytic anemia and azotemic oliguric renal failure. Urinalysis can reveal proteinuria, microscopic hematuria, and red blood cells or hyaline casts in the urine.

Diffuse intrarenal ischemia leads to an increase in the level of renin, angiotensin II and aldosterone in plasma, which leads to hypovolemia and hypokalemia. Sodium abnormalities are common and can be dangerous.

In addition, a chest x-ray is taken, which can be useful for examining heart enlargement, pulmonary edema, or abnormalities in other chest structures, including changes in the ribs from coarctation of the aorta or enlargement of the mediastinum due to aortic dissection.

Other tests, including computed tomography (CT) of the head, echocardiography, and renal angiography, are only done as directed by initial therapy.

Electrocardiography and echocardiography

Electrocardiography (ECG) is an important diagnostic tool for detecting ischemia, heart attack, or signs of electrolyte disturbances or drug overdose. In the earliest stages of malignant hypertension, ECG and echocardiography can detect left atrial enlargement and left ventricular hypertrophy.

Treatment

Patients with malignant hypertension are usually referred to the intensive care unit for continuous cardiac monitoring, neurological assessment, and intravenous antihypertensive drugs. Patients, as a rule, use autoregulation of altered blood pressure (BP). An excessive decrease in blood pressure to control levels can lead to organ hypoperfusion.

Hypertension does not require hospitalization. The goal of treatment in these cases is to reduce blood pressure within 24 hours, which can be achieved on an outpatient basis.

Pharmacological therapy

The initial goal of treatment is to reduce mean arterial pressure by about 25% during the first two days. The intra-arterial line is useful for continuous blood pressure monitoring. Low sodium levels can be severe, so consider increasing your intake of isotonic sodium chloride solutions. Secondary causes of hypertension should also be investigated.

There are no studies comparing the effectiveness of different drugs in the treatment of malignant hypertension. Medicines are selected based on their speed, ease of use, special situations and treatment conditions.

The most commonly used intravenous drug is nitroprusside. An alternative for patients with renal insufficiency is intravenous fenoldopam. Labetalol is another common alternative that provides an easy transition from intravenous to oral administration. However, clinical research has shown that intravenous calcium blockers (eg, nicardipine) may be useful for rapidly and safely lowering blood pressure to target levels and appear to be more effective than intravenous labetalol.

Beta blockade can be performed intravenously with esmolol or metoprolol. Parenteral diltiazem, verapamil and enalapril are also available. Oral medication should be started as soon as possible to facilitate the transition to outpatient treatment.

Complications

Correct diagnosis of malignant hypertension is essential for proper treatment; however, lowering blood pressure too quickly can be harmful to the patient. In particular, an excessive decrease in blood pressure can lead to organ hypoperfusion, and damage to the target organ. Please note that taking enalapril has an unpredictable response in people with hypovolemia, with a possible uncontrolled decrease in blood pressure.

In addition, all patients should be carefully evaluated for secondary causes of hypertension, and the patient should be closely monitored after discharge. They should be aware of signs and symptoms that require immediate medical attention.

Diet

Initially, individuals undergoing treatment for malignant hypertension are instructed to fast until they are stable. Once stabilized, patients are given long-term recommendations for hypertension, including a low-salt diet. If necessary, adherence to a diet is prescribed, which can lead to weight loss.

Physical activity during treatment is limited to bed rest until the patient is stabilized. It should be possible to resume normal activities on an outpatient basis after blood pressure is controlled.

Prophylaxis

The best way to prevent further episodes of hypertension emergencies is to ensure that the patient is closely monitored outpatiently for hypertension management. This is usually done by a general practitioner, but referral to a specialist cardiologist should also be considered for individuals requiring multiple drug therapy or additional secondary therapy.

Forecast

Before effective therapy was available, life expectancy for people with malignant hypertension was less than 2 years, with the majority of deaths attributable to stroke, kidney failure, or heart failure. The survival rate after 1 year was less than 25%, and after 5 years - less than 1%. However, with modern therapy, including dialysis, the survival rate after 1 year exceeds 90%, and after 5 years - 80%. The most common cause of death is cardiovascular disease, with frequent stroke and kidney failure.

A British study that looked at 40-year survival statistics in 446 patients with malignant hypertension showed an even higher 5-year survival rate. The authors determined that prior to 1977, the 5-year survival rate was 32%, while for patients diagnosed between 1997 and 2006, the 5-year rate was 91%. The researchers suggested that the change was associated with lower goals and tighter blood pressure control, as well as the presence of additional classes of antihypertensive drugs. The authors also found that age, baseline creatinine, and subsequent systolic blood pressure were independent predictors of survival.