Malignant or Accelerated Hypertension

Cardiology (12%) Core Clinical Conditions

1B: Able to identify the condition as a possible diagnosis: may not have the knowledge or resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Malignant or accelerated hypertension is a severe form of high blood pressure with associated organ damage. This condition can cause organ failure and can be fatal if left untreated. This is a medical emergency. A common finding is a diastolic level above 130mmHg. 

Not fully understood. Studies have shown that it is generally caused by the following: 

• Genetics

• Environmental causes 

• Obesity 

• Diabetes 

• CKD

• Family history of HTN 

HTN causes damage to blood vessels and organs such as the kidney, heart and other organs. The constriction of the blood vessels reduces blood flow to the organs. The diminished blood supply damages vital organs like the heart, brain, and kidneys. If left untreated, the elevated blood pressure might develop blood vessel permeability, resulting in fluid collection in multiple organs.

• Family history of heart disease

• Smoker

• Obesity

• Diabetes

• Uncontrolled HTN

• Chest pain

• Severe headache

• Shortness of breath

• Fatigue and weakness

• Blurred vision

• Nausea and vomiting

• Tachycardia

Diagnosis is often picked by a clinician during a physical examination and history.

Investigations may include the following: 

• Blood pressure check 

• Urine test - which may reveal presence of protein in the urine 

• Blood test

• ECHO 

• CT scan 

• MRI of the brain

Generally speaking malignant HTN should be treated in the hospital: 

• If blood pressure is above 180/120 mmHg, he or she must be referred to the hospital if organ damage, such as retinal haemorrhage, and life-threatening symptoms are present.

• If organ damage is present with a blood pressure exceeding 180/120, NICE suggests an antihypertensive can be considered without the results of a home blood pressure monitor (HBPM) or an ambulatory blood pressure monitor (ABPM).

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