Accelerated hypertension (malignant hypertension) is the term used to describe severe hypertension (180mmHg systolic and 110mmHg diastolic) occurring with retinopathy of Grade III (flame haemorrhages, dot and blot haemorrhages, hard and soft exudates) to Grade IV (papilloedema).1 The finding of accelerated hypertension in a patient demands urgent referral for assessment and treatment in order to minimise end-organ damage and reduce the risk of life threatening events such as myocardial infarction, encephalopathy, and intracerebral or subarachnoid haemorrhage.
Malignant hypertension is a complication of hypertension characterized by very elevated 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. Systolic and diastolic blood pressures are usually greater than 200 and 140, respectively. Treatment: A commonly used drug is IV fenoldopam. Labetalol is another common alternative, providing easy transition from IV to oral (PO) dosing. Beta-blockade can be accomplished intravenously with esmolol or metoprolol. Hydralazine is reserved for use in pregnant patients, while phentolamine is the drug of choice for a pheochromocytoma crisis. iv sodium nitroprusside should never be used as it can cause a rapid uncontrollable drop in blood pressure.
Um....a big word?
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