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malignant hypertension
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This is a distinctive form of hypertension characterised by vascular fibrinoid necrosis and loss of precapillary arteriolar autoregulation. It is a medical emergency as blood pressure may rise acutely - to a diastolic level greater than 130 mm Hg.
Suggested indications for referral to secondary care include:
- if there is urgent treatment indicated
- severe hypertension (e.g. 220/120 mmHg)
- impending complications e.g. TIA
- NICE suggest (1):
-
identifying who to refer for same-day specialist review
- if a person has severe hypertension (clinic blood pressure of
180/120 mmHg or higher), but no symptoms or signs indicating same-day
referral, carry out investigations for target organ damage as
soon as possible:
- if target organ damage is identified, consider starting antihypertensive drug treatment immediately, without waiting for the results of ABPM or HBPM.
- If no target organ damage is identified, repeat clinic
blood pressure measurement within 7 days
- refer people for specialist assessment, carried out on the same day, if they have a clinic blood pressure of 180/120 mmHg and higher with:
- signs of retinal haemorrhage or papilloedema (accelerated hypertension) or
- life-threatening symptoms such as new onset confusion, chest
pain, signs of heart failure, or acute kidney injury
- refer people for specialist assessment, carried out on the same
day, if they have suspected phaeochromocytoma (for example, labile
or postural hypotension, headache, palpitations, pallor, abdominal
pain or diaphoresis)
- if a person has severe hypertension (clinic blood pressure of
180/120 mmHg or higher), but no symptoms or signs indicating same-day
referral, carry out investigations for target organ damage as
soon as possible:
-
Malignant hypertension may complicate the course of both essential and secondary hypertension. Occasionally, it may be the initial manifestation of high blood pressure.
Reference:
Last edited 09/2019 and last reviewed 09/2019
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