Skip to main content
SpringerLink
Log in

Accelerated/Malignant Hypertension

  • Chapter
  • First Online:
Disorders of Blood Pressure Regulation

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

  • 1873 Accesses

Abstract

Malignant or accelerated hypertension represents the most severe form of hypertension, defined clinically by very high blood pressure in association with bilateral retinal haemorrhages and/or exudates, with or without papilloedema. The aim of this chapter is to discuss the diagnostic challenges and the consequences of the target organ damage.

The prognosis of malignant hypertension improved significantly over the last decades, but there is no strong evidence to suggest a reduction in its incidence. In fact, it could become even more common with the growing population in the developing countries that have limited healthcare resources. Despite the diagnostic criteria of malignant hypertension appear to be simple, the diagnoses may be difficult in substantial proportion of patients. Malignant hypertension patients often present at the advanced stages of the target organ damage. Furthermore, retrospective diagnosis is problematic, as malignant hypertension and the accompanying ocular changes may gradually resolve, while persistent target organ damage can drive the development of complications and has an adverse prognosis in these patients. Certainly, malignant hypertension still presents a clinically relevant form of hypertension, and it should be kept in mind during the assessment of patients with poorly controlled hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Keith NM, Wagener HP, Barker NW (1974) Some different types of essential hypertension: their course and prognosis. Am J Med Sci 268(6):336–345

    Article  CAS  PubMed  Google Scholar 

  2. Ahmed ME, Walker JM, Beevers DG, Beevers M (1986) Lack of difference between malignant and accelerated hypertension. Br Med J (Clin Res Ed) 292(6515):235–237

    Article  CAS  Google Scholar 

  3. Cremer A, Amraoui F, Lip GY et al (2016) From malignant hypertension to hypertension-MOD: a modern definition for an old but still dangerous emergency. J Hum Hypertens 30:463–466

    Article  CAS  PubMed  Google Scholar 

  4. Lip GY, Beevers M, Beevers G (1994) The failure of malignant hypertension to decline: a survey of 24 years’ experience in a multiracial population in England. J Hypertens 12(11):1297–1305

    Article  CAS  PubMed  Google Scholar 

  5. Leishman AW (1959) Hypertension: treated and untreated; a study of 400 cases. Br Med J 1(5134):1361–1368

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kincaid-Smith P (1991) Malignant hypertension. J Hypertens 9(10):893–899

    Article  CAS  PubMed  Google Scholar 

  7. Kadiri S, Olutade BO, Osobamiro O (2000) Factors influencing the development of malignant hypertension in Nigeria. J Hum Hypertens 14(3):171–174

    Article  CAS  PubMed  Google Scholar 

  8. Kadiri S, Olutade BO (1991) The clinical presentation of malignant hypertension in Nigerians. J Hum Hypertens 5(4):339–343

    CAS  PubMed  Google Scholar 

  9. McGregor E, Isles CG, Jay JL, Lever AF, Murray GD (1986) Retinal changes in malignant hypertension. Br Med J (Clin Res Ed) 292(6515):233–234

    Article  CAS  Google Scholar 

  10. Steinegger K, Bergin C, Guex-Crosier Y (2015) Malignant hypertension: clinical manifestations of 7 cases. Klin Monatsbl Augenheilkd 232(4):590–592. doi:10.1055/s-0034-1396333

    Article  CAS  PubMed  Google Scholar 

  11. Browning AC, Mengher LS, Gregson RM, Amoaku WM (2001) Visual outcome of malignant hypertension in young people. Arch Dis Child 85(5):401–403

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Rodriguez MA, Kumar SK, De Caro M (2010) Hypertensive crisis. Cardiol Rev 18(2):102–107. doi:10.1097/CRD.0b013e3181c307b7

    Article  PubMed  Google Scholar 

  13. Balogh Z, Berta A, Pfliegler G, Nagy V (2011) Bilateral central retinal vein occlusion caused by malignant hypertension in a young patient. Clin Exp Hypertens 33(1):53–55. doi:10.3109/10641963.2010.503304

    Article  PubMed  Google Scholar 

  14. Shukla D, Ramchandani B, Vignesh TP et al (2010) Localized serous retinal detachment of macula as a marker of malignant hypertension. Ophthalmic Surg Lasers Imaging 1–7. doi: 10.3928/15428877-20100215-74

  15. Chen YH, Kuo HK, Kao ML (2003) Malignant hypertensive retinopathy-clinical and fundus manifestations in patients with new onset or acute exacerbation of chronic hypertension. Chang Gung Med J 26(9):669–677

    PubMed  Google Scholar 

  16. Hayreh SS, Servais GE, Virdi PS et al (1986) Fundus lesions in malignant hypertension. III. Arterial blood pressure, biochemical, and fundus changes. Ophthalmology 93(1):45–59

    Article  CAS  PubMed  Google Scholar 

  17. Hayreh SS, Servais GE, Virdi PS (1986) Fundus lesions in malignant hypertension. IV. Focal intraretinal periarteriolar transudates. Ophthalmology 93(1):60–73

    Article  CAS  PubMed  Google Scholar 

  18. Heidbreder E, Huller U, Schafer B, Heidland A (1987) Severe hypertensive retinopathy. Increased incidence in renoparenchymal hypertension. Am J Nephrol 7(5):394–400

    Article  CAS  PubMed  Google Scholar 

  19. Cortina G, Hofer J, Giner T, Jungraithmayr T (2015) Severe visual loss caused by unrecognized malignant hypertension in a 15-year-old girl. Pediatr Int 57(2):e42–e44. doi:10.1111/ped.12525

    Article  PubMed  Google Scholar 

  20. Kadiri S, Thomas JO (1993) Kidney histology and clinical correlates in malignant hypertension. East Afr Med J 70(2):112–116

    CAS  PubMed  Google Scholar 

  21. Pitcock JA, Johnson JG, Hatch FE et al (1976) Malignant hypertension in blacks. Malignant intrarenal arterial disease as observed by light and electron microscopy. Hum Pathol 7(3):333–346

    Article  CAS  PubMed  Google Scholar 

  22. Shavit L, Reinus C, Slotki I (2010) Severe renal failure and microangiopathic hemolysis induced by malignant hypertension—case series and review of literature. Clin Nephrol 73(2):147–152

    Article  CAS  PubMed  Google Scholar 

  23. Li X, Zhang W, Ren H et al (2009) Malignant hypertension complicated by acute renal failure. BMJ Case Rep 1–8. doi: 10.1136/bcr.10.2008.1116

  24. Tao JL, Li H, Tang Y et al (2008) Lupus nephritis complicated with malignant hypertension: from renal vascular pathology to clinical relevance. Chin Med Sci J 23(2):81–87

    Article  CAS  PubMed  Google Scholar 

  25. Davies DL, Beevers DG, Briggs JD et al (1973) Abnormal relation between exchangeable sodium and the renin-angiotensin system in malignant hypertension and in hypertension with chronic renal failure. Lancet 1(7805):683–686

    Article  CAS  PubMed  Google Scholar 

  26. Leemingsawat C, Thongtang N (2012) Malignant hypertension due to a large reninoma: a case report. J Med Assoc Thai 95(Suppl 2):S251–S255

    PubMed  Google Scholar 

  27. van den Born BJ, Koopmans RP, van Montfrans GA (2007) The renin-angiotensin system in malignant hypertension revisited: plasma renin activity, microangiopathic hemolysis, and renal failure in malignant hypertension. Am J Hypertens 20(8):900–906. doi:10.1016/j.amjhyper.2007.02.018

    Article  PubMed  Google Scholar 

  28. Gassanov N, Pollok M, Er F (2009) Acute renal failure associated with malignant hypertension. Dtsch Med Wochenschr 134(44):2224–2227. doi:10.1055/s-0029-1241930

    Article  CAS  PubMed  Google Scholar 

  29. Lip GY, Beevers M, Beevers DG (1997) Does renal function improve after diagnosis of malignant phase hypertension? J Hypertens 15(11):1309–1315

    Article  CAS  PubMed  Google Scholar 

  30. Lip GY, Beevers M, Beevers DG (2000) Do patients with de novo hypertension differ from patients with previously known hypertension when malignant phase hypertension occurs? Am J Hypertens 13(8):934–939

    Article  CAS  PubMed  Google Scholar 

  31. Amraoui F, Bos S, Vogt L, van den Born BJ (2012) Long-term renal outcome in patients with malignant hypertension: a retrospective cohort study. BMC Nephrol 13:71. doi:10.1186/1471-2369-13-71

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lip GY, Beevers M, Beevers DG (1995) Complications and survival of 315 patients with malignant-phase hypertension. J Hypertens 13(8):915–924

    Article  CAS  PubMed  Google Scholar 

  33. van der Merwe W, van der Merwe V (2013) Malignant hypertension: a preventable emergency. N Z Med J 126(1380):39–45

    PubMed  Google Scholar 

  34. Gosse P, Coulon P, Papaioannou G et al (2011) Impact of malignant arterial hypertension on the heart. J Hypertens 29(4):798–802. doi:10.1097/HJH.0b013e3283430b12

    Article  CAS  PubMed  Google Scholar 

  35. Shantsila A, Dwivedi G, Shantsila E et al (2013) A comprehensive assessment of cardiac structure and function in patients with treated malignant phase hypertension: the West Birmingham Malignant Hypertension project. Int J Cardiol 167(1):67–72. doi:10.1016/j.ijcard.2011.11.077

    Article  PubMed  Google Scholar 

  36. Shapiro LM, Mackinnon J, Beevers DG (1981) Echocardiographic features of malignant hypertension. Br Heart J 46(4):374–379

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Shantsila A, Dwivedi G, Shantsila E et al (2011) Persistent macrovascular and microvascular dysfunction in patients with malignant hypertension. Hypertension 57(3):490–496. doi:10.1161/HYPERTENSIONAHA.110.166314

    Article  CAS  PubMed  Google Scholar 

  38. Akimoto T, Muto S, Ito C et al (2011) Clinical features of malignant hypertension with thrombotic microangiopathy. Clin Exp Hypertens 33(2):77–83. doi:10.3109/10641963.2010.503303

    Article  CAS  PubMed  Google Scholar 

  39. Acelajado MC, Calhoun DA (2010) Resistant hypertension, secondary hypertension, and hypertensive crises: diagnostic evaluation and treatment. Cardiol Clin 28(4):639–654. doi:10.1016/j.ccl.2010.07.002

    Article  PubMed  Google Scholar 

  40. Vaughan CJ, Delanty N (2000) Hypertensive emergencies. Lancet 356(9227):411–417. doi:10.1016/S0140-6736(00)02539-3

    Article  CAS  PubMed  Google Scholar 

  41. Deguchi I, Uchino A, Suzuki H, Tanahashi N (2012) Malignant hypertension with reversible brainstem hypertensive encephalopathy and thrombotic microangiopathy. J Stroke Cerebrovasc Dis 21(8):915.e17–915.e20. doi:10.1016/j.jstrokecerebrovasdis.2012.02.005

    Google Scholar 

  42. Polgreen LA, Suneja M, Tang F et al (2015) Increasing trend in admissions for malignant hypertension and hypertensive encephalopathy in the United States. Hypertension 65(5):1002–1007. doi:10.1161/HYPERTENSIONAHA.115.05241

    Article  CAS  PubMed  Google Scholar 

  43. Shantsila A, Shantsila E, Lip GY (2010) Malignant hypertension: a rare problem or is it underdiagnosed? Curr Vasc Pharmacol 8(6):775–779

    Article  CAS  PubMed  Google Scholar 

  44. van den Born BJ, Koopmans RP, Groeneveld JO, van Montfrans GA (2006) Ethnic disparities in the incidence, presentation and complications of malignant hypertension. J Hypertens 24(11):2299–2304. doi:10.1097/01.hjh.0000249710.21146.38

    Article  PubMed  Google Scholar 

  45. Lane DA, Lip GY, Beevers DG (2009) Improving survival of malignant hypertension patients over 40 years. Am J Hypertens 22(11):1199–1204. doi:10.1038/ajh.2009.153

    Article  PubMed  Google Scholar 

  46. Seedat YK (1999) Improvement in treatment of hypertension has not reduced incidence of end-stage renal disease. J Hum Hypertens 13(11):747–751

    Article  CAS  PubMed  Google Scholar 

  47. Kanaheswari Y, Hamzaini AH, Wong SW, Zulfiqar A (2008) Malignant hypertension in a child with phakomatosis pigmentovascularis type II b. Acta Paediatr 97(11):1589–1591. doi:10.1111/j.1651-2227.2008.00971.x

    Article  CAS  PubMed  Google Scholar 

  48. Zgurzynski P, Manno M (1999) Coccygeal fracture, constipation, convulsion, and confusion: a case report of malignant hypertension in a child. Pediatr Emerg Care 15(6):425–428

    Article  CAS  PubMed  Google Scholar 

  49. Chaubey BS, Soni PH, Grover S (1984) Malignant hypertension in a young boy. J Assoc Physicians India 32(3):289–291

    CAS  PubMed  Google Scholar 

  50. Liborio AB, Marques Fde O, Testagrossa L et al (2005) Malignant hypertension with intestinal ischemia secondary to juxtaglomerular cell tumor. Am J Kidney Dis 46(5):957–961. doi:10.1053/j.ajkd.2005.07.032

    Article  PubMed  Google Scholar 

  51. Moorthy N, Prasad BN, Kumar YC et al (2009) Malignant hypertension, dissection of aorta, cardiac tamponade and monoparesis—unusual presentation of Takayasu’s arteritis: clinicopathological correlation. Int J Cardiol 133(3):e114–e117. doi:10.1016/j.ijcard.2007.12.042

    Article  PubMed  Google Scholar 

  52. Petitti DB, Klatsky AL (1983) Malignant hypertension in women aged 15 to 44 years and its relation to cigarette smoking and oral contraceptives. Am J Cardiol 52(3):297–298

    Article  CAS  PubMed  Google Scholar 

  53. Tadokoro K, Nishikimi T, Mori Y et al (2003) Altered gene expression of adrenomedullin and its receptor system and molecular forms of tissue adrenomedullin in left ventricular hypertrophy induced by malignant hypertension. Regul Pept 112(1–3):71–78

    Article  CAS  PubMed  Google Scholar 

  54. Lip GY, Edmunds E, Hee FL et al (2001) A cross-sectional, diurnal, and follow-up study of platelet activation and endothelial dysfunction in malignant phase hypertension. Am J Hypertens 14(8 Pt 1):823–828

    Article  CAS  PubMed  Google Scholar 

  55. Edmunds E, Landray MJ, Li-Saw-Hee FL et al (2001) Dyslipidaemia in patients with malignant-phase hypertension. QJM 94(6):327–332

    Article  CAS  PubMed  Google Scholar 

  56. Clough CG, Beevers DG, Beevers M (1990) The survival of malignant hypertension in Blacks, Whites and Asians in Britain. J Hum Hypertens 4(2):94–96

    CAS  PubMed  Google Scholar 

  57. Amraoui F, Van Der Hoeven NV, Van Valkengoed IG et al (2014) Mortality and cardiovascular risk in patients with a history of malignant hypertension: a case-control study. J Clin Hypertens (Greenwich) 16(2):122–126. doi:10.1111/jch.12243

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK

    Alena Shantsila M.D. & Gregory Y. H. Lip M.D.

Authors
  1. Alena Shantsila M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory Y. H. Lip M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory Y. H. Lip M.D. .

Editor information

Editors and Affiliations

  1. Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Adel E. Berbari

  2. Emeritus Professor of Medicine, University of Milano-Bicocca, Monza, Italy

    Giuseppe Mancia

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Shantsila, A., Lip, G.Y.H. (2018). Accelerated/Malignant Hypertension. In: Berbari, A., Mancia, G. (eds) Disorders of Blood Pressure Regulation. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-59918-2_38

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-59918-2_38

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59917-5

  • Online ISBN: 978-3-319-59918-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation