Copy of hypertension-treatment-breakthrough.pptx.pdf

Malignant Hypertension
Malignant Hypertension
A Critical Medical Emergency

1. Intern doctor, faculty of medicine, university of Benghazi A Critical Medical Emergency
by: Yousif Aboaziza 18.05.2024 Malignant HypertensionMalignant Hypertension

2. Definition pathophysiology
clinical features
and diagnosis
management
and treatment
strategies
Objectives
01 02
03 04

3. Introduction
Hypertension is the most common modifiable risk factor
for cardiovascular diseases
Approximately of 1% hypertension pts may develop
hypertensive crisis during their lifetime
higher rates have been reported in African Americans,
low social economics people and in developing countries
incidence in men is two times higher than in woman
despite being common it’s inadequately treated

4. WHAT IS MALIGNANT
HYPERTENSION ?
WHAT IS MALIGNANT
HYPERTENSION ?

5. A severe form of hypertension
characterized by markedly elevated
blood pressure (typically >180/120
mmHg) with evidence of acute end-
organ damage.

6. Vascular Injury
Renin-Angiotensin Ischemia
PATHOPHYSIOLOGY
Severe hypertension leads
to endothelial damage,
resulting in fibrinoid
necrosis of arterioles
Activation leads to further
vasoconstriction and
aldosterone secretion,
worsening hypertension
Organ ischemia due to
reduced perfusion.

7. Clinical
Presentation
and Diagnosis

8. Clinical Features
Symptoms:
Severe headache, visual disturbances (blurring,
scotomas), confusion, seizures.
Signs:
Hypertensive retinopathy (papilledema), renal
impairment (hematuria, proteinuria), cardiovascular
abnormalities (left ventricular hypertrophy).

9. Laboratory Tests
Blood urea nitrogen (BUN),
creatinine, urinalysis.
Blood Pressure
Measurement
Diagnosis
Imaging
Fundoscopy for retinal changes
chest X-ray,
ECG, echocardiography.
Other
Consider renal ultrasound
CT scan if secondary causes are
suspected
Confirm with multiple readings

11. Severe elevation in blood pressure
(typically >180/120 mm Hg)
No evidence of acute end-organ
damage
Management: Oral antihypertensive
agents, gradual blood pressure
reduction over 24-48 hours
Follow-up: Outpatient monitoring
Severe elevation in blood pressure
(typically >180/120 mm Hg)
Presence of acute end-organ damage
(e.g., encephalopathy, retinopathy,
myocardial infarction, acute kidney injury)
Management: Intravenous antihypertensive
agents, rapid but controlled bp reduction
Follow-up: Intensive care unit monitoring
Urgency vs
Emergency

12. Management
and Treatment
Management
and Treatment

13. Management Goals
Immediate Treatment:
Lower blood pressure by no more than 25% within
the first hour.
Reach a target BP of 160/100 mmHg over the next
2-6 hours.
Long-Term Control:
Gradual BP reduction over days.

14. Initial
Treatment
• IV Medications:
Nitroprusside, labetalol, nicardipine.
Individualize based on patient profile and comorbidities.
• Monitoring:
Continuous BP monitoring in an ICU setting.
Frequent assessment of organ function.

15. Ongoing
Treatment
• Oral Medications:
Transition to oral antihypertensives as BP stabilizes (ACE
inhibitors, ARBs, calcium channel blockers, beta-blockers).
• Lifestyle Modifications:
Diet (low-sodium), weight management, exercise, smoking
cessation.

16. Emergencies and the appropriate
antihypertensive medication is preferred Acute Pulmonary Edema
Acute Coronary Syndrome
Aortic Dissection
Acute Renal Failure
Preeclampsia/Eclampsia
Hypertensive Encephalopathy
Subarachnoid Hemorrhage
Beta-Blockers
Nitroglycerin
Beta-Blockers + Nitroprusside
Fenoldopam
Hydralazine
Labetalol
Nimodipine

18. is their a relation between
hypertension and
caffeine ?
is their a relation between
hypertension and
caffeine ?

19. References:
European Journal of Clinical Nutrition. "Caffeine and caffeine metabolites in relation to
hypertension in U.S. adults."
1.
American Heart Association Journals. "Caffeine and Blood Pressure."2.

20. for your kind attention