Cardiology · Pathway 53
Malignant Hypertension
Key points
- Severe hypertension (e.g. > 200/130 mmHg) with fibrinoid necrosis of vessels → retinal haemorrhages/exudates, proteinuria/haematuria; can cause cerebral oedema → encephalopathy.
- Features: severe headache, nausea/vomiting, visual disturbance; chest pain and dyspnoea common; papilloedema; severe → encephalopathy (seizures).
- Management: reduce diastolic no lower than 100 mmHg within 12–24 h; bed rest.
- Most patients: oral therapy (e.g. atenolol); severe/encephalopathic → IV sodium nitroprusside or labetalol.
Decision points in this pathway
- Encephalopathic (seizures/confusion) or severe?
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