MALIGNANT HYPERTENSION

Dr.dr. Todung Silalahi SpPD-KKV,FINASIM,FICA,FAPSIC,FACC,FSCAI

Divisi Kardiologi-Vaskular, Depertement Penyakit Dalam
FKIK UKRIDA
2019
• Malignant hypertension is a term that has been used
to describe patients with elevated blood pressure (BP)
and multiple complications with a poor prognosis.
• Person with malignant hypertension has a blood
pressure that's typically above 180/120.
• The diagnosis can be further classified as a
hypertensive emergency when severe elevation in BP
is associated with end-organ damage, or hypertensive
urgency when severe hypertension occurs without it
Causes Malignant
Hypertension
1. Collagen vascular disease Scleroderma
2. Central nervous system disorders, such as head injury,
cerebral infarction, and cerebral hemorrhage
3. Kidney disease
4. Spinal cord injuries
5. Tumor of the adrenal gland
6. Use of certain medication including birth control pills and
Monoamine oxidase inhibitors (MAOIs)
7. Use of illegal drugs coccain, amphetamines
8. Antihypertensive medication withdrawal
Epidemiology
• Hypertensive emergencies are unusual, with a
projected incidence of 1 to 2 cases per million per
year.
• Emergency department (ED) visits have more than
doubled from 2006 to 2013  Few examples include
1. eclampsia (2%)
2. cerebral infarction (39%)
3. acute pulmonary edema (25%).
Pathophysiology
Hypertensive emergencies occur when a relatively rapid
elevation of BP develops in a short period. Increase in
systemic vascular resistance by an increase in
vasoconstriction mechanisms through renin-angiotensin
activation, pressure natriuresis, hypoperfusion, and
ischemia are the most common culprits of end-organ
damage
Symptoms
Other symptoms of malignant hypertension include:
1. Blurred vision
2. Chest pain (angina)
3. Difficulty breathing
4. Dizziness
5. Numbness in the arms, legs, and face
6. Severe headache
7. Shortness of breath
Malignant hypertension can cause brain swelling
1. Blindness
2. Changes in mental status
3. Coma
4. Confusion
5. Drowsiness
6. Headache that continues to get worse
7. Nausea and vomiting
8. Seizures
Diagnosis
1. Physical examination heart & lung
2. Examine eyes  retina and swelling
3. Blood urea nitrogen (BUN) and creatinine levels, which
increase if you have kidney damage
4. Blood clotting tests
5. Blood sugar (glucose) level
6. Complete blood count
7. Sodium and potassium levels
8. Urinalysis to check for blood, protein, or abnormal hormone
levels related to kidney problems
Imaging tests :
1. ECG
2. X-ray  lung
3. Echocardiography
Management Malignant
Hypertension
Immediate medical treatment decreases your chances for
life-threatening complications
Complication
1. Aortic dissection, which is a sudden rupture of the
main blood vessel leaving the heart
2. Coma
3. Fluid in the lungs pulmonary edema
4. Heart attack
5. Heart failure
6. Stroke
7. Sudden kidney failure
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