Treatment of malignant hypertension

An emergency hypertensive is evidenced by markedly elevated blood pressure and target organ damage. This situation requires immediate attention to prevent disability or death. Here, the treatment aim is to reduce the blood pressure promptly but partially to prevent end-organ damage without compromising tissue perfusion. The initial target is to lower the mean arterial pressure (MAP) by no more than 25%, or reduce the diastolic blood pressure by one-third.

MAP = diastolic blood pressure + [(systolic BP – diastolic BP)/3].

Mechanisms of Malignant Hypertension.

Even in the presence of heart failure or hypertensive encephalopathy, a controlled reduction, to a level of about 150/90 mmHg, over a period of 24–36 hours is ideal.

Hypertensive Urgencies and Treatment.

Hypertensive Emergencies and Treatment.

In most patients, blood pressure can be brought down with bed rest and oral medication. Intravenous labetalol (2 mg/min to a maximum of 200 mg), intravenous glyceryl trinitrate (0.6–1.2 mg/h), intravenous sodium nitroprusside (0.3–1.0 mg/kg per min) or intramuscular hydralazine (5 or 10 mg repeated at half-hourly intervals) are all effective but require close monitoring.

Drugs Used in the Treatment of Hypertensive Crises.

Further reading:

1. Kitiyakara C, Guzman NJ. Malignant hypertension and hypertensive emergencies. J Am Soc Nephrol 1998;9:133-42. [PubMed]