Malignant hypertension: does this still exist?

Domek, Magdalena; Gumprecht, Jakub; Lip, Gregory Y.H.; Shantsila, Alena

doi:10.1038/s41371-019-0267-y

Cited by 18 publications

(14 citation statements)

References 37 publications

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“…Furthermore, no cases of malignant hypertension were detected in our population. Once again this data may be due to diagnostic difficulties in an emergency setting [16], as well as to the relatively low prevalence of the disease, reported having an annual incidence of 2 per 100,000 in the Caucasian population [17].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department

Vallelonga

Carbone

Benedetto

et al. 2020

JCM

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Background: A hierarchical symptoms-based diagnostic strategy relying on the presence of five main symptoms (chest pain, acute dyspnea, neurological symptoms, headache, visual impairment) was recently proposed to diagnose patients with hypertensive emergency. However, poor scientific evidence is available about the role of symptoms in both diagnosis and management of acute hypertensive disorders. Methods: Data from 718 patients presenting to the emergency department of the “Città della Salute e della Scienza” Hospital of Turin with systolic blood pressure > 180 and/or diastolic blood pressure > 110 mm/Hg were retrospectively analyzed. The accuracy of the typical symptoms for identification of hypertensive emergencies was assessed. Results: A total of 79 (11%) out of 718 patients were diagnosed with hypertensive emergencies (51% had cardiovascular and 49% neurovascular acute organ damage). Patients with hypertensive emergencies were older and with higher prevalence of coronary artery disease and chronic heart failure than patients with uncontrolled hypertension. Typical symptoms could discriminate true hypertensive emergency from uncontrolled hypertension with 64% accuracy, 94% sensitivity, and 60% specificity. Conclusion: Typical symptoms might be used as a simple screening test (99% negative predictive value) in the emergency department to select for further evaluations of patients with suspected hypertensive emergencies among those with acute hypertensive disorders.

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Section: Discussionmentioning

confidence: 99%

Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department

Vallelonga

Carbone

Benedetto

et al. 2020

JCM

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“…Se a terapia intravenosa é sempre necessária é uma questão de debate, devido aos relatos recentes de que a medicação oral também pode resultar na redução controlada da PA. A prevenção de déficits neurológicos é um objetivo crucial no tratamento da HTM, especialmente por causa de seu curso muitas vezes assintomático e possibilidades diagnósticas limitadas. No entanto, a condição com maior risco de vida, a encefalopatia hipertensiva, é uma emergência rara com início súbito de sintomas que facilita o diagnóstico diferencial (Domek et al, 2020;Nattes et al,2021)…”

Section: Resultsunclassified

“…Para fazer um diagnóstico de hipertensão maligna, o papiledema deve estar presente. Na hipertensão maligna, a chave é baixar a pressão arterial em poucas horas (Lee et al,2019;Domek et al, 2020;Naranjo et al,2022).…”

Section: Introductionunclassified

Fisiopatologia da hipertensão maligna: uma revisão da literatura

Junior

Cavalcanti

Negreiros

et al. 2022

RSD

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A hipertensão maligna é um termo que tem sido utilizado para descrever pacientes com pressão arterial (PA) elevada e múltiplas complicações (lesão de órgão-alvo) com prognóstico ruim. Hoje, o termo crise hipertensivo é empregado para descrever pacientes que apresentam elevações graves da PA da seguinte forma: Pressão arterial sistólica (PAS) maior que 180 mmHg e pressão arterial diastólica (PAD) maior que 120 mm Hg. O presente estudo tem como objetivo analisar a fisiopatologia da hipertensão maligna. Trata-se de um estudo de abordagem qualitativa, onde se adotou a revisão integrativa da literatura, que conforme Galvão (2012), é uma construção de uma análise ampla da literatura com passos pré-definidos. Realizado através da Biblioteca Virtual de Saúde (BVS) nas bases de dados do Pubmed, usando os cruzamentos dos descritores em inglês “malignant hypertension”, “diagnosis”. Dos diferentes tipos de emergências hipertensivas, a hipertensão maligna (HTM) é caracterizada por elevações extremas da PA e danos microvasculares agudos que afetam vários órgãos, em particular a retina, o cérebro e os rins. A HTM provavelmente é subdiagnosticada, sendo classificada como emergência hipertensiva ou não atendida por vários motivos. A hipertensão maligna é uma doença sistêmica que causa graves danos ao cérebro, coração, rins e olhos. Os bloqueadores do sistema renina-angiotensina parecem ser a base do tratamento. É necessária uma gestão do manejo clínico da hipertensão por meio do consenso obtido a partir de experiência clínica e evidências de qualidade inadequada.

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“…aHUS is characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury and can also present as progressive kidney damage, or as extrarenal manifestations resulting in damage to other organs [5][6][7]. Another condition that can result in TMA is malignant hypertension (MHT), a severe form of arterial hypertension traditionally diagnosed by high blood pressure (diastolic pressure > 120 mmHg) with papilledema/hypertensive retinopathy [8][9][10][11][12]. More recent experience has emphasized the role of multi-organ involvement/damage in the diagnosis and prognosis of MHT, and MHT with multi-organ involvement has also been referred to as hypertensive emergency [10,13].…”

Section: Introductionmentioning

confidence: 99%

“…Another condition that can result in TMA is malignant hypertension (MHT), a severe form of arterial hypertension traditionally diagnosed by high blood pressure (diastolic pressure > 120 mmHg) with papilledema/hypertensive retinopathy [8][9][10][11][12]. More recent experience has emphasized the role of multi-organ involvement/damage in the diagnosis and prognosis of MHT, and MHT with multi-organ involvement has also been referred to as hypertensive emergency [10,13]. The kidneys are frequently affected in patients with MHT, and patients often present with elevated serum creatinine, proteinuria, hemolysis, low platelet count, and kidney failure, all of which are also key markers of TMA [10,14].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and outcomes of a patient population with atypical hemolytic uremic syndrome and malignant hypertension: analysis from the Global aHUS registry

et al. 2022

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Introduction Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) often caused by alternative complement dysregulation. Patients with aHUS can present with malignant hypertension (MHT), which may also cause TMA. Methods This analysis of the Global aHUS Registry (NCT01522183) assessed demographics and clinical characteristics in eculizumab-treated and not-treated patients with aHUS, with (n = 71) and without (n = 1026) malignant hypertension, to further elucidate the potential relationship between aHUS and malignant hypertension. Results While demographics were similar, patients with aHUS + malignant hypertension had an increased need for renal replacement therapy, including kidney transplantation (47% vs 32%), and more pathogenic variants/anti-complement factor H antibodies (56% vs 37%) than those without malignant hypertension. Not-treated patients with malignant hypertension had the highest incidence of variants/antibodies (65%) and a greater need for kidney transplantation than treated patients with malignant hypertension (65% vs none). In a multivariate analysis, the risk of end-stage kidney disease or death was similar between not-treated patients irrespective of malignant hypertension and was significantly reduced in treated vs not-treated patients with aHUS + malignant hypertension (adjusted HR (95% CI), 0.11 [0.01–0.87], P = 0.036). Conclusions These results confirm the high severity and poor prognosis of untreated aHUS and suggest that eculizumab is effective in patients with aHUS ± malignant hypertension. Furthermore, these data highlight the importance of accurate, timely diagnosis and treatment in these populations and support consideration of aHUS in patients with malignant hypertension and TMA. Trial registration details Atypical Hemolytic-Uremic Syndrome (aHUS) Registry. Registry number: NCT01522183 (first listed 31st January, 2012; start date 30th April, 2012). Graphical abstract

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Malignant hypertension: does this still exist?

Cited by 18 publications

References 37 publications

Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department

Accuracy of a Symptom-Based Approach to Identify Hypertensive Emergencies in the Emergency Department

Fisiopatologia da hipertensão maligna: uma revisão da literatura

Clinical characteristics and outcomes of a patient population with atypical hemolytic uremic syndrome and malignant hypertension: analysis from the Global aHUS registry

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