Hypertension malignant/accelerated

Patients with malignant-accelerated hypertension can usually be managed by oral therapy. Patients who are seen in a nursing home or clinic, whose BP is found to be above some arbitrary danger level like a BP of 180/120 should not automatically be given nifedipine sublingually. Indiscriminate use of nifedipine sublingually could lead to a major catastrophe like myocardial infarction or cerebrovascular episodes. Nifedipine activates sympathetic response and leads to precipitous drops of blood pressure followed by rebound hypertension. 

Accelerated or malignant hypertension Promptly initiate captopril at 25 mg 2 or 3 times daily under close supervision. Increase dose every 24 hours or less until a satisfactory response is obtained or the maximum dose is reached. 

Accelerated hypertension - Nicotine therapy constitutes a risk factor for development of malignant hypertension in patients with accelerated hypertension. Inhaler therapy should be used with caution in these patients and only when the benefits of including nicotine replacement in a smoking cessation program outweigh the risks. 

Accelerated phase (malignant) hypertension rarely requires urgent reduction, and should instead be regarded as an indication for slow reduction in blood pressure during the first few days. 

Accelerated phase hypertension was previously called malignant hypertension because the lack of treatment heralded death within a year of diagnosis. It is characterised pathologically by fibrinoid necrosis of the small arteries. An important consequence is the loss of autoregulation of the cerebral and renal circulation, so that any reduction in blood pressure causes a proportional fall in perfusion of... 

Diazoxide, which is administered intravenonsly, is nsed exclusively in the management of malignant hypertension or a hypertensive crisis. It brings abont reflex cardiac acceleration and increased cardiac ontpnt. However, it can cause hyperglycemia due to its inhibition of insnUn release from the beta cells. Becanse diazoxide also prodnces sodinm and water retention, it shonld be given with a dinretic snch as furosemide or ethacrynic acid. 

Malignant hypertension Accelerated hypertension causing rapid damage to vessels in end organs a medical emergency... 

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