Hypertension malignant

Once essential hypertension develops, management of this disorder becomes a lifetime task. When a direct cause of the hypertension can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks first, with tumors or other abnormalities of the adrenal glands following. In malignant hypertension the diastolic pressure usually exceeds 130 mm Hg. In secondary hypertension,... 

Malignant hypertension is a dangerous condition that develops rapidly and requires immediate medical attention. Fbtients with malignant hypertension experience organ damage as die result of hypertension. Target organs of hypertension include the heart, kidney, and eyes (retinopadiy). 

Notify the primary care provider if the diastolic pressure suddenly increases to 130 mm Hg or higher you may have malignant hypertension. 

Warfarin is used cautiously in patients with fever, heart failure, diarrhea, malignancy, hypertension, renal or hepatic disease, psychoses, or depression. Women of childbearing age must use a reliable contraceptive to prevent pregnancy. 

G6PD deficiency is discussed in Chapters 20 and 52 and malignant hyperthermia in Chapter 49. At least one gene other than that encoding the ryanodine receptor is involved in certain cases of malignant hypertension. Many other examples of drug reactions based on polymorphism or mutation are available. 

Hemophilia or other hemorrhagic tendencies Severe liver disease with elevated baseline PT Severe thrombocytopenia (platelet count less than 20,000) Malignant hypertension... 

Contraindications to heparin therapy include hypersensitivity to the drug, active bleeding, hemophilia, severe liver disease with elevated prothrombin time (PT), severe thrombocytopenia, malignant hypertension, and inability to meticulously supervise and monitor treatment. 

Treatment generally includes reinstitution of therapy, bed rest/sedation and, perhaps, therapy similar to treatment of malignant hypertension. 

Hospitalize any patient with malignant hypertension during initial treatment to ensure that blood pressure is not falling more rapidly than intended. 

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. 

After the patient is out of danger a careful search should be done to exclude a secondary cause for the malignant hypertension. The patient should then be put on a regime of multiple drug therapy. 

Diazoxide is administered intravenously for the treatment of hypertensive emergencies, particularly malignant hypertension, hypertensive encephalopathy, and eclampsia. It is effective in 75 to 85% of the patients to whom it is administered and rarely reduces blood pressure below the normotensive range. 

Oral anticoagulants are ordinarily contraindicated in the presence of active or past gastrointestinal ulceration thrombocytopenia hepatic or renal disease malignant hypertension recent brain, eye, or spinal cord surgery bacterial endocarditis chronic alcoholism and pregnancy. These agents also should not be prescribed for individuals with physically hazardous occupations. 

Since these nitrate-based compounds cause blood vessels to dilate, they are called nitrovasodilators. Nitrovasodilators have clinical utility in the treatment of angina and in the treatment of malignant hypertension (high blood pressure that is severely out of control). Some of the available nitrovasodilator products include amyl nitrite (4.228), nitroglycerin (4.229), isosorbide dinitrate (4.230), erythrityl tetranitrate (4.231), pentaery-thritol tetranitrate (4.232) and sodium nitroprusside (4.233). 

Combined arteriolar and venodilator Releases NO spontaneously activates guanylyl cyclase Marked vasodilation reduces preload and afterload Acute cardiac decompensation hypertensive emergencies (malignant hypertension) IV only duration 1-2 min. Toxicity Excessive hypotension, thiocyanate and cyanide toxicity Interactions Additive with other vasodilators... 

The course of malignant hypertension in man was reversed readily by this agent, and blood pressure in benign cases lowered. No hypotensive effect was noted when the enzyme was inactivated. 

Hypertensive encephalopathy is a classic feature of malignant hypertension. Its clinical presentation consists of severe headache, mental confusion, and apprehension. Blurred vision, nausea and vomiting, and focal neurologic deficits are common. If untreated, the syndrome may progress over a period of 12-48 hours to convulsions, stupor, coma, and even death. 

I use Nipride, which I have never had fail to control the BP in patients with Cushing s, primary aldosteronism, renal artery stenosis, pheochromocytoma, and scleroderma with malignant hypertension. 

Grim CE. Management of malignant hypertension. Comprehensive Therapy 1980 6 44-48. 

This drug causes dilation of resistance vessels (arterioles) but not of capacitance vessels (venules). Minoxidil [mi NOX i dill] is administered orally for treatment of severe to malignant hypertension that is... 

Cocaine can cause acute renal insufficiency (SEDA-21,19) (SEDA-24, 38). Acute renal insufficiency, with malignant hypertension, apparently precipitated by... 

Antithrombin inhibits the activity of factors Ka, Xa, Xlla, and thrombin (Ila). It also inhibits thrombin-induced activation offactors V and VIII. UFH prevents the growth and propagation of a formed thrombus and allows the patient s own thrombolytic system to degrade the clot. Contrainchcations to heparin therapy include hypersensitivity to the drug, active bleeding, hemophilia, severe hver chsease with elevated prothrombin time (PT), severe thrombocytopenia, malignant hypertension, and inability to meticulously supervise and monitor treatment. 

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