Malignant Hypertension Symptoms Treatment

Malignant Hypertension and accelerated high blood pressure are two emergency conditions which should be treated promptly. Both conditions have same outcome and therapy. However Malignant hypertension is a complication of high blood pressure characterized by very elevated high blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. It differs from other complications of hypertension in that it is accompanied by papilledema. (Edema of optic disc of eye) Systolic and diastolic blood pressures are usually greater than 240 and 120, respectively. While Accelerated high blood pressure is condition with high blood pressure, target organ damage, on fundoscopy we have flame shaped hemorrhages, or soft exudates, but without papilledema.

There are two things. Hypertensive Urgency and Hypertensive emergency. In hypertensive urgency we don’t see any target organ damage while in emergency we see target organ damage along with high blood pressure greater than systolic >220. Now depending upon target organ damage you will decide whether you have hypertensive emergency or urgency. It is essential to bring down high blood pressure in hypertensive emergency immediately, while in urgency, bring down blood pressure very rapidly is not required.

Pathogenesis of malignant hypertension is fibrinoid necrosis of arterioles and small arteries. Red blood cells are damaged as they flow through vessels obstructed by fibrin deposition, resulting in microangiopathic hemolytic anemia. Another pathologic process is the dilatation of cerebral arteries resulting in increased blood flow to brain which leads to clinical manifestations of hypertensive encephalopathy. Common age is above 40 years and it is more frequent in man rather than women. Black people are at higher risk of developing hypertensive emergencies than the general population.

Target organs are mainly Kidney, CNS and Heart. So symptoms of Malignant hypertension are oligurea, Headache, vomiting, nausea, chest pain, breathlessness, paralysis, blurred vision. Most commonly heart and CNS are involved in malignant hypertension. The pathogenesis is not fully understood. Up to 1% of patients with essential hypertension develop malignant hypertension, and the reason some patients develop malignant hypertension while others do not is unknown. Other causes include any form of secondary hypertension; use of cocaine, MAOIs, or oral contraceptives; , beta-blockers, or alpha-stimulants. Renal artery stenosis, withdrawal of alcohol, pheochromocytoma {most pheochromocytomas can be localized using CT scan of the adrenals}, aortic coarctation, complications of pregnancy and hyperaldosteronism are secondary causes of hypertension. Main Investigations to access target organ damage are complete renal profile, BSR, Chest Xray, ECG, Echocardiography, CBC, Thyroid function tests.

Management:

Patient is admitted in Intensive Care Unit. An intravenous line is taken for fluids and medications. The initial goal of therapy is to reduce the mean arterial pressure by approximately 25% over the first 24-48 hours. However Hypertensive urgencies do not mandate admission to a hospital. The goal of therapy is to reduce blood pressure within 24 hours, which can be achieved as an outpatient department. Initially, patients treated for malignant hypertension are instructed to fast until stable. Once stable, all patients with malignant hypertension should take low salt diet, and should focus on weight lowering diet. Activity is limited to bed rest until the patient is stable. Patients should be able to resume normal activity as outpatients once their blood pressure has been controlled.

Hospitalization is essential until the severe high blood pressure is under control. Medications delivered through an IV line, such as nitroglycerin, nitroprusside, or others, may reduce your blood pressure. An alternative for patients with renal insufficiency is IV fenoldopam. Beta-blockade can be accomplished intravenously with esmolol or metoprolol. Labetalol is another common alternative, providing easy transition from IV to oral (PO) dosing. Also available parenterally are enalapril, diltiazem, verapamil, Hydralazine is reserved for use in pregnant patients as it also increases uterine profusion, while phentolamine is the drug of choice for a pheochromocytoma crisis. After the severe high blood pressure is brought under control, regular anti-hypertensive medications taken by mouth can control your blood pressure. The medication may need to be adjusted occasionally.

Remember, It is very necessary to control malignant hypertension, otherwise it can lead to life threatening conditions like Heart Failure, Infarction, Kidney failure and even blindness.

Dr Armughan, Author of this article. Read More about Malignant Hypertension

Natural Hypertension Treatment

Hypertension quite simply is a chronic elevation of blood pressure. It is the most common cardiovascular disease, and is the leading cause of stroke, as well as a major cause of heart attacks. Unfortunately often people do not even realize that they suffer from hypertension. They can readily not even know until it is too late. As if the ailment is not enough to want to seek out natural hypertension treatment, hypertension can also cause damage to not only the heart, but other bodily organs such as the liver, kidneys and brain.

The normal systolic number in a blood pressure reading should be around 140, while the normal diastolic reading is about 90. Systole is the heart rate as it is beating, while the diastole is the heart at rest. A phase of pre-hypertension can occur with a consistent systole reading of between 120 and 139 and a diastole of between 80 and 89. It is a good idea to get natural hypertension treatment during this phase in order to avoid the onset of full blown hypertension.

As a person ages if their systolic blood pressure reading increases too much, it is considered essential hypertension. Likewise when issues begin to arise in the brain, liver, or kidneys, this is referred to as malignant hypertension. As is signified with the term “malignant”, this type of hypertensions needs to be aggressively addressed immediately.

Causes of hypertension that can be addressed by natural hypertension treatment include anxiety, tension, stress, over-emotional reactions such as anger, jealousy or shock as well as vital organ malfunctions.

Systolic pressure naturally increases in some people, but hereditary factors in addition to poor diet can greatly contribute to the onset of hypertension. In order to determine the presence of hypertension and possible address with natural hypertension treatment individuals should be aware of the symptoms.

Some symptoms present with hypertension include feeling unstable and dizzy, palpitations, difficulty sleeping, and possible digestive issues. Results stemming from hypertension can include bleeding of the eyes due to narrow capillaries and too much blood pressure force, heart attack, and arterial hemorrhage.

Natural hypertension treatment can be accomplished with strict dietary regime, proper amount of sleep and consistent sleep pattern, appropriate amount and level of exercise and avoiding stress. Along the lines of diet people with hypertension or at risk of developing it should avoid spicy foods, salt, chocolate and other sweets, hydrogenated oils, foods high in carbohydrates and limit red meat. Food items beneficial for natural hypertension treatment include parsley, alfalfa, garlic and other types of herbs that further research could bring to light for one searching for a natural hypertension treatment.

Naturally a doctor should be consulted before taking any homeopathic remedies.

Hypertension quite simply is a chronic elevation of blood pressure. Everyone should get regular physicals so that if a problem is developing it can be detected and treated immediately to avoid worsening conditions. Anyone diagnosed with hypertension should be sure to follow the guidelines put forth by their doctor. These likely will include proper diet, exercise, sleep and as much elimination of stress as possible.

Understanding Hypertension – Facts You May Need

What is hypertension?

Hypertension or high blood pressure is the increased rise in the pressure of blood in the arteries. It increases the risk of associated cardiovascular (heart) diseases such as stroke, myocardial infarction, failure of kidneys or heart, other vascular complications.

What are the blood pressure ranges?

Normal pressure of blood according to current guidelines is < 130 and < 85. In hypertension the treatment is influenced by the presence of other risk factors such as pre-existing heart diseases and diabetes.

A list of the hypertension ranges from normal to risk levels are given in the table below;

Category
Systolic (mm Hg)
Diastolic (mm Hg)
Optimal
<120
<80
Normal
<130
<85
High normal
130-139
85-89
Mild hypertension
140-159
90-99
Moderate hypertension
160-179
100-109
Severe hypertension
≥180
≥110
Isolated systolic hypertension
≥140
<90
Source: J Hypertens 1999; 17(2): 151-183

What is blood pressure?

The heart supplies oxygenated or pure blood to all parts of the body through the help of vessels called arteries. The force with which the blood pushes against the walls of the artery is known as BP.

The heart pumps blood into the arteries as it is beating. The pressure exerted on the artery walls when it is being filled with blood is known as systolic pressure and is 120 normally.

The heart relaxes between the beats or pumping the blood into the arteries. This is the time when the pressure falls, and is known as diastolic pressure. The diastolic pressure is normally 80.

What causes hypertension?

Majority (about 95%) of patients have essential hypertension or primary hypertension. The main reasons behind this hypertension are known to be;

Genetic factors: hypertension tends to run in families and children of hypertensive parents tend to have a greater tendency of hypertension.

Fetal factors: low birth weight is known to be associated with subsequent hypertension. This may be due to the fact that the fetus adapts to the intrauterine under nutrition and which may bring about long term changes in the blood vessels.

Obesity: fat people are at a greater risk of hypertension as compared with normal people. Fat or obese people also show abnormal sleep tendencies which may cause further complications of hypertension.

Alcohol intake: research has shown a close association between alcohol consumption and increased pressure.

Sodium intake (salt intake): a high sodium intake is a major factor in increased BP. A shift from rural to urban lifestyle is also associated with an increase in salt uptake and hence an increase in the risk of high BP.

Stress: acute pain or stress can rise blood pressure, but the role of chronic stress in hypertension is still unknown.

Smoking

Ageing

Vitamin D deficiency

Changes in autonomic nervous system: the autonomic system is known to bring about indirect changes in the blood pressure levels.

Insulin resistance or Type II Diabetes: insulin resistance causes increased levels of insulin in blood, an intolerance of body towards glucose, decreased levels of high density lipids and all this is known to cause an increased risk of cardiovascular diseases including hypertension.

Remaining percentage of population has secondary hypertension which is caused as a result of underlying diseases. This is known as secondary hypertension and it has a cause which can be essentially treated. These are;

Renal diseases such as diabetic nephropathy

Hormonal disorders

Cardiovascular diseases which are there by virtue of birth

Use of drug e.g. oral contraceptive pills, steroids, NSAID’s, liqourice and vasopressin. These drugs may either cause hypertension or interfere in the action of drugs acting against hypertension.

Pregnancy: pregnancy induced hypertension is a disorder which goes after the delivery of the baby. Sometimes the hypertension is followed with an increased concentration of proteins in the urine. This condition is known as pre-eclampsia and may be fatal to the mother.

What are the symptoms of hypertension?

Sometimes the person with high BP can go for years without showing any outwardly symptoms. Therefore it is important that people go for regular checkups to avoid complications later on. The symptoms if at all present are;

Severe headache
Fatigue
Confusion
Dizziness
Nausea
Visual problems
Chest pain
Breathing problem
Irregular heartbeat
Blood in the urine

What are the target organs affected?

The target organs that are prone to be damaged as a result of prehypertension and systemic hypertension are kidney, other cardiovascular organs, and brain & retina. Various diseases that can be caused as a result of chronic hypertension are chronic kidney disease, myocardial infarction, congestive heart failure, dementia, stroke, ventricular tachycardia and fibrillation.

Glossary of terms

Stroke: A sudden loss of consciousness resulting when the rupture or occlusion of a blood vessel leads to oxygen lack in the brain.

Myocardial infarction: Destruction of heart tissue resulting from obstruction of the blood supply to the heart muscle.

Congestive heart failure: Inability to pump enough blood to avoid congestion in the tissues.

Dementia: Mental deterioration of organic or functional origin.

Ventricular tachycardia: Abnormally rapid heartbeat (over 100 beats per minute).

Ventricular fibrillation: Fibrillation of heart muscles resulting in interference with rhythmic contractions of the ventricles and possibly leading to cardiac arrest.