Definition

• Malignant hypertension, also referred to as hypertensive emergency
  • An abrupt increase of blood pressure in a patient with underlying hypertension or the sudden onset of hypertension in a previously normotensive individual
  • Malignant hypertension is a syndrome and is not defined solely by a specific blood pressure measurement, although the diastolic blood pressure is usually > 120 mmHg.
    • Absolute level of blood pressure is not as important as its rate of rise.
  • Clinically, the syndrome is recognized by acute end-organ damage.
    • Progressive retinopathy (arteriolar spasm, hemorrhages, exudates, and papilledema)
    • Deteriorating renal function with proteinuria
    • Microangiopathic hemolytic anemia
    • Encephalopathy
  • Pathologically, the syndrome is associated with:
    • Diffuse necrotizing vasculitis
    • Arteriolar thrombi
    • Fibrin deposition in arteriolar walls: Fibrinoid necrosis has been observed in arterioles of kidney, brain, retina, and other organs.

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