home Consultations Causes of malignant hypertension and methods of its elimination. Malignant hypertension Malignant hypertension occurs in all diseases except

Causes of malignant hypertension and methods of its elimination. Malignant hypertension Malignant hypertension occurs in all diseases except

Hypertension is called malignant when the blood pressure is raised significantly. This pathology is diagnosed in less than 1% of cases of hypertension. The malignant form of hypertension is dangerous for its complications and requires treatment without fail.

General characteristics of the disease, mechanism of development

Malignant hypertension progresses rapidly. Blood pressure steadily rises, reaching more than 230/130 mm Hg. Art.

Malignant hypertension can be a primary pathology or develop against the background of classical hypertension. The disease in the primary form occurs 4-5 times less frequently.

Men are at risk of developing the disease. According to statistics, more, especially after 40 years. In old age, this pathology occurs abruptly. More often it affects smokers.

The development of the clinical picture occurs quickly, taking several weeks or months. In the blood, the concentration of vasoconstrictive elements sharply increases. Then the water-electrolyte balance is disturbed, causing hyponatremia (a decrease in the concentration of sodium ions) and hypovolemia (a decrease in the volume of circulating blood). Often such phenomena are accompanied by hypokalemia (the concentration of potassium ions in the blood decreases).

The changes that have occurred lead to microangiopathies, that is, pathological lesions of small blood vessels. All these factors affect the state of small arteries (arterioles) and vascular tone. Changes in the structure of blood vessels lead to increased renal ischemia and insufficiency, and hypertension is exacerbated.

The process is reversible. In some cases, correction of blood pressure within a month can reverse vascular changes. This leads to the complete disappearance of the clinical manifestations of pathology.

Causes

Finding out the cause of malignant hypertension is not always possible. In this case, essential hypertension is diagnosed. Such a disease is hereditary and usually manifests itself in adulthood, causing damage to target organs (heart, kidneys, blood vessels).

If the causes of the disease are clear, then there is symptomatic arterial hypertension. This means that the pathology is caused by another disease:

Pheochromocytoma (50% of cases). This neoplasm in the adrenal medulla produces catecholamines, which increase blood pressure.
Renovascular hypertension (30% of cases). The disease affects the vessels of the kidneys, reducing the amount of blood they receive. As a result, the kidneys produce a large amount of substances that increase blood pressure.
Primary aldosteronism (10% of patients). This formation in the adrenal cortex produces aldosterone. This hormone increases blood pressure.
Damage to kidney tissue (in 10% of cases).
Tumor of the kidneys (rare).

Malignant hypertension can be caused not by one cause, but by a combination of them. Such cases are the least favorable.

Symptoms of malignant hypertension

The onset of the disease is usually asymptomatic. Later, the disease manifests itself with rather striking signs:

nausea turning into vomiting;
convulsions;
sharp, loss of consciousness (peak of high pressure);

persistent increase in pressure in the absence of its normalization;
a rapid increase in pressure and increased damage to internal organs - all this happens in a matter of days;
failures in attentiveness, memory, vision, with damage to the fundus, blindness is possible;
pressing pains behind the sternum during exercise, soothed by taking medications from the nitrate group (expand the blood vessels of the heart);
an increase in general weakness, swelling of the face, a decrease in temperature;
weight loss.

Blood pressure does not decrease even at night at rest. At this time, the indicators may even exceed the results of daily measurements.

Often, vascular damage is expressed by retinopathy: the optic disc swells on both sides, retinal hemorrhage, exudation occurs.

Diagnosis of pathology begins with the collection and analysis of anamnesis. They find out when the pressure has increased, to what extent, what symptoms it is accompanied by. The diseases suffered by the patient and his close relatives, the medications taken, the presence of contact with toxic substances are important.

On examination, attention is paid to the color of the skin, swelling, the weight of the patient, the volume of his waist and hips. Blood pressure is measured on both arms and legs. Carry out auscultation of the heart with large vessels.

An additional examination by an ophthalmologist is necessary. He will assess the condition of the fundus and identify complications.

To confirm malignant hypertension, the results of clinical and instrumental diagnostics are important:

Blood and urine tests can detect kidney damage. In this case, there is proteinuria, hematuria, cylindruria. The relative density of urine decreases, and the concentration of creatinine and urea in the blood increases. Also important are the parameters of cholesterol, potassium, uric acid and sugar, which are detected in a biochemical blood test.
Pressure monitoring. Diagnostics should be carried out during the day in order to evaluate the performance at different times of the day, during wakefulness, sleep. An analysis of the morning rise in pressure is important.
Electrocardiogram. A prolonged increase in pressure is manifested by an increase and overload of the left parts of the heart.
Echocardiography. This ultrasound scanning method shows an enlarged left atrium and left ventricle, as well as impaired relaxation.
Doppler ultrasound. The specialist evaluates large arteries, revealing their narrowing.
Ultrasound of the thyroid gland, kidneys, adrenal glands.
CT scan. This examination is an x-ray technique and allows you to evaluate the structure of the kidneys and adrenal glands.
Angiography of the vessels of the kidneys. This technique is also X-ray and involves the introduction of contrast. Diagnosis is needed to identify areas of narrowing of the renal arteries.

In malignant hypertension, a differential diagnosis is required to distinguish it from severe hypertension and primary hyperaldosteronism (Conn's syndrome).

Treatment of malignant hypertension

It is important to start treatment as early as possible to avoid serious complications. The patient needs to give up and, normalize body weight and increase physical activity, but dose it.

Necessary . Its main principles are as follows:

salt restriction (no more than 4 grams per day);
restriction of animal fats;
more foods enriched with microelements: potassium, calcium and magnesium (dairy products, bananas).

If the cause of malignant hypertension has been established, then treatment should be based on its elimination.

Conservative therapy

The first step in the treatment of malignant hypertension should be the normalization of pressure. The diastolic indicator should reach 110 mm Hg. Art. during the day. To do this, use short-acting drugs from among:

calcium antagonists;
β-blockers;
peripheral vasodilators;
drugs of central action.

In the treatment of patients with malignant hypertension, simultaneous administration of three antihypertensive drugs is necessary. For continuous use, drugs with a long-term effect are selected in order to smoothly control the pressure.

The dosage of antihypertensive drugs is calculated individually. During the day, the pressure should decrease by a maximum of 25%, while diastole should reach 100-110 mm Hg. Art. The complex of drugs is selected individually from among the following means:

calcium antagonists;
β-blockers;
combined α- and β-blockers;
ACE inhibitors (angiotensin-converting enzyme);
sartans (ACE receptor antagonists);
imidazoline receptor antagonists;
diuretics.

Surgical intervention

If renal failure becomes severe, then conservative treatment does not work. The patient undergoes a nephrectomy, that is, the kidney or part of it is removed. After that, organ transplantation or replacement therapy with program hemodialysis is necessary.

Possible complications, prognosis

The malignant form of the disease can lead to various complications:

stroke (most cases of complications);
coronary heart disease (angina pectoris, heart failure, myocardial infarction);
ischemic kidney disease;
blindness
kidney infarction;
kidney necrosis.

The prognosis for malignant hypertension is unfavorable, but modern drugs have had a positive effect on it. After the diagnosis, most patients live for at least a year. In 75%, their life expectancy is more than 5 years. Death is more often due to a stroke.

Prevention

The danger of malignant hypertension lies in the suddenness of development with existing hypertension of a benign nature. The main measures to prevent this form of the disease are as follows:

smoking cessation and;
timely and correct therapy of any pathologies that cause an increase in pressure.

At the first sign of malignant hypertension, you need to contact a specialist. The sooner the pathology is detected and correct therapy is started, the higher the chances of success and a favorable life prognosis.

Initial diagnostic tests for malignant hypertension include CBC and electrolyte (including calcium), blood urea, creatinine, glucose, coagulation profile, and urinalysis.

Other laboratory tests are prescribed only in accordance with the instructions of therapy. These may include measurements of cardiac enzymes, urinary catecholamines, and thyroid-stimulating hormone.

Kidney function is assessed with a urinalysis, a complete chemical profile, and a complete blood count. Expected results include increased blood urea and creatinine levels, hyperphosphatemia, hyperkalemia or hypokalemia, impaired glucose metabolism, acidosis, hypernatremia, and evidence of microangiopathic hemolytic anemia and azotamic oliguric renal failure. Urinalysis may reveal proteinuria, microscopic hematuria, and erythrocytes or hyaline casts in the urine.

Diffuse intrarenal ischemia leads to an increase in plasma levels of renin, angiotensin II and aldosterone, leading to hypovolemia and hypokalemia. Abnormal sodium levels are common and can be dangerous.

In addition, a chest x-ray is taken, which may be useful to look for heart enlargement, pulmonary edema, or abnormalities of other chest structures, including changes in the ribs due to coarctation of the aorta or mediastinal enlargement due to aortic dissection.

Other tests, including computed tomography (CT) of the head, echocardiography, and renal angiography, are ordered only as directed by initial therapy.

Electrocardiography and echocardiography

Electrocardiography (ECG) is an important diagnostic tool for detecting ischemia, infarction, or signs of electrolyte imbalance or drug overdose. In the earliest stages of malignant hypertension, ECG and echocardiography reveal left atrial enlargement and left ventricular hypertrophy.

Treatment

Patients with malignant hypertension are usually referred to an intensive care unit for ongoing cardiac monitoring, neurologic assessment, and intravenous antihypertensive medication. Patients, as a rule, use autoregulation of altered blood pressure (BP). An excessive decrease in blood pressure to control levels can lead to organ hypoperfusion.

Hypertension does not require hospitalization. The goal of treatment in these cases is to reduce blood pressure within 24 hours, which can be achieved on an outpatient basis.

Pharmacological therapy

The initial goal of treatment is to reduce mean arterial pressure by about 25% during the first two days. The intra-arterial line is useful for continuous BP monitoring. Decreased sodium levels can be severe, so consider increasing the intake of isotonic sodium chloride solutions. Secondary causes of hypertension should also be investigated.

There are no studies comparing the effectiveness of different drugs in the treatment of malignant hypertension. Medicines are selected based on their speed of action, ease of use, special situations and treatment conditions.

The most commonly used intravenous drug is nitroprusside. An alternative for patients with renal insufficiency is the intravenous administration of fenoldopam. Labetalol is another common alternative that provides an easy transition from intravenous to oral administration. However, a clinical study has shown that intravenous calcium blockers (eg, nicardipine) may be useful in lowering blood pressure quickly and safely to target levels and appear to be more effective than intravenous labetalol.

Beta blockade can be done intravenously with esmolol or metoprolol. Parenteral diltiazem, verapamil, and enalapril are also available. Oral medications should be started as soon as possible to facilitate transition to outpatient treatment.

Complications

Proper diagnosis of malignant hypertension is essential for proper treatment; however, lowering blood pressure too quickly can harm the patient. In particular, an excessive decrease in blood pressure can lead to organ hypoperfusion, and damage to the target organ. Please note that enalapril has an unpredictable response in hypovolemic individuals, with possible uncontrolled reduction in blood pressure.

In addition, all patients should be carefully evaluated for secondary causes of hypertension, and the patient should be followed closely after discharge. They should be aware of signs and symptoms that require immediate medical attention.

Diet

Initially, people undergoing treatment for malignant hypertension are instructed to fast until stable. After stabilization, patients are given long-term recommendations for hypertension, including a low-salt diet. If necessary, a diet is prescribed, which can lead to weight loss.

Physical activity during the treatment period is limited to bed rest until the patient is stabilized. It should be possible to resume normal activities on an outpatient basis after blood pressure is controlled.

Prevention

The best way to prevent further episodes of hypertension emergencies is to ensure that the patient receives careful outpatient monitoring for hypertension treatment. This is usually done by an internist, but referral to a specialist cardiologist should also be considered for individuals who need complex drug therapy or additional secondary therapy.

Forecast

Prior to the advent of effective therapy, life expectancy for people with malignant hypertension was less than 2 years, with most deaths due to stroke, kidney failure, or heart failure. The survival rate at 1 year was less than 25% and at 5 years it was less than 1%. However, with modern therapy, including dialysis, survival after 1 year exceeds 90%, and after 5 years - 80%. The most common cause of death is cardiovascular, with frequent stroke and kidney failure.

A British study that looked at 40-year survival rates in 446 patients with malignant hypertension found an even higher 5-year survival rate. The authors determined that prior to 1977, the 5-year survival rate was 32%, while for patients who were diagnosed between 1997 and 2006, the 5-year rate was 91%. The researchers speculated that the change was due to lower targets and tighter BP control, as well as the availability of additional classes of antihypertensive drugs. The authors also found that age, baseline creatinine, and subsequent systolic BP were independent predictors of survival.

The disease is characterized by very high blood pressure, as a result of which severe changes in the vascular walls occur. Most often, the disease leads to dangerous consequences and the development of various pathologies. This disease is very dangerous for human life, so therapeutic measures should begin as soon as possible. Without treatment, malignant arterial hypertension is most often fatal.

In most cases, the disease occurs due to a malignant tumor of the adrenal glands, but there are other causes of development. Such as:

Severe kidney disease;
Pathology of the adrenal glands;
Stenosis of the renal artery;
Severe renal failure.

In addition, malignant arterial hypertension can be caused by the misuse of certain medications. Also, the disease can occur in people who abuse bad habits (alcohol, smoking, drugs).

When harmful substances enter the body, a sharp narrowing of blood vessels occurs. This very often aggravates the course of hypertension and leads to the fact that it passes into a malignant stage.

Symptoms

Malignant arterial hypertension is always accompanied by a number of symptoms. The first thing that begins to bother the patient is headaches. They can be aching, pressing or shooting in nature. Most often, the pain syndrome occurs in the early morning and intensifies by lunchtime. Localization of pain, as a rule, in the back of the head, but can also be given to the parietal part.

Constant morning headache - an alarm signal of your body

In addition, the patient almost always has:

sudden weight loss;
Significant deterioration of the condition;
blanching of the skin;
Respiratory failure, in particular, shortness of breath;
Loss of visual acuity;
Decreased appetite;
Apathy and increased anxiety;
Feeling of tightness in the chest;
Rapid heartbeat and/or increased pulse.

Also, every third patient with malignant hypertension has a strong decrease in body temperature and / or cold extremities.

Note. In addition, this type of hypertension is accompanied by persistently high blood pressure and, in almost all cases, sleep disturbance. This is explained by the fact that the increase in blood pressure occurs most often at night, due to which the patient's condition worsens significantly. This is what leads to sleep problems.

Diagnostics

To make an accurate diagnosis, you will need to undergo a series of clinical examinations. Without them, it is impossible to determine the disease. In addition to the fact that at the initial stage the doctor collects complete information about the patient (existing diseases, symptoms present, etc.), procedures such as:

General analysis of blood and urine;
Control of daily blood pressure;
Ultrasound examination of the heart, as well as the thyroid gland;
echocardiography;
Electrocardiography.

In addition to these diagnostic measures, a combined study (UZDG) is prescribed. Using this method of examination, the doctor can assess the condition of the patient's vessels and make an almost unmistakable diagnosis. Also, to determine the general condition of the patient, the therapist can prescribe a consultation and examination of other doctors - a cardiologist, an ophthalmologist, an endocrinologist and a neuropathologist.

Treatment

Many diseases at the initial stage can be cured with the help of various decoctions and herbal infusions. This does not apply to malignant arterial hypertension. It can only be cured with the help of pharmaceutical drugs.

Therapeutic measures, as with any other disease, are aimed at treating the disease that caused the pathology, relieving symptoms and improving the patient's condition. For these purposes, medicines, traditional medicine (as a supplement), diet therapy, as well as various preventive measures can be used.

Malignant arterial hypertension is a serious disease, so only a doctor prescribes the necessary treatment

Medical therapy

The main group of medicines:

Any treatment is selected by the doctor. It will not work to combine drugs on your own, because each course of the disease is individual and there is no specific treatment regimen that would suit everyone. Therapy is selected depending on the cause of the disease, symptoms, age of the patient, and also based on the individual characteristics of the organism.

First of all, it is necessary to reduce blood pressure by 20-25% of the already existing indicators, since constantly high pressure adversely affects the vital organs. For these purposes, as a rule, three or four component treatment is used. Drugs and the rate of admission is determined for each patient individually, but most often therapy is prescribed according to the following schemes:

Diuretics (diuretics) in combination with calcium antagonists and beta-blockers.
ACE inhibitors supplemented with diuretics and calcium antagonists.
Beta-blockers with calcium antagonists, as well as ACE inhibitors.
A T1 receptor antagonists with diuretics and calcium channel blockers.
If malignant hypertension is supplemented by diabetes mellitus, then the most effective will be the use of alpha-adrenergic receptor antagonists in combination with imidazoline receptor agonists and the mandatory inclusion of ACE inhibitors in the regimen.

Blood pressure should be lowered to normal levels, but gradually. A sharp decline is unacceptable, as this can only aggravate the situation. After the pressure is normalized, the doctor prescribes complex drug therapy.

Important! Self-selection of schemes to reduce blood pressure is prohibited. This most often leads to aggravating consequences, including the death of the patient.

Principles of non-drug treatment

Along with medicines, a good addition that enhances the therapeutic effect are:

Body weight control;
Rejection of all bad habits;
The use of vitamin complexes;
Normalization of diet, rest and sleep;
Doing sports;
Limiting salt and fluid intake;
Eating food rich in vitamins and minerals.

In addition, constant monitoring of blood pressure and regular visits to the attending physician are required. This will help track the dynamics of treatment and determine its effectiveness. If the prescribed therapy does not bring the desired effect, the doctor adjusts the treatment and gives new recommendations.

If the patient's condition is assessed as poor, then most often he is referred for inpatient treatment. In this case, the therapy will take place under the close supervision of a specialist.

Consequences

Like any dangerous disease, malignant hypertension most often leaves any consequences. The most frequent of them:

Ischemia;
Stroke;
loss of vision;
Renal failure.

In addition, chronic anemia, hemorrhages and other equally dangerous pathologies may appear.

Forecast

The disease belongs to the group of life-threatening pathologies. If left untreated, malignant hypertension is 100% fatal. In the case of timely intervention by a specialist and timely treatment, the patient has an improvement already in the first month of treatment.

To achieve positive dynamics, you must strictly follow the recommendations of the doctor, and under no circumstances stop the course of treatment. Only in this case, you can get a good result and improve your health as quickly as possible.

Prevention

Any disease can be prevented by adhering to some preventive measures. The development of malignant hypertension can be avoided if:

To refuse from bad habits;
Eat healthy food;
Monitor body weight and do not overeat;
Exclude junk food from the diet (fried, spicy, salty, etc.);
Avoid stress, which adversely affects the entire body;
Maintain physical fitness;
Do not cancel or adjust the treatment of arterial hypertension on your own.

According to statistics, a person who does not treat malignant arterial hypertension dies within 4-6 months. It is important to remember this and not neglect your health. A course of treatment started in time will improve the quality of life and live long and happy years.

Timely treatment is always the key to recovery, do not neglect your health!

Arterial hypertension is a gradual and prolonged increase in a patient's blood pressure (>140/90 mm Hg) - which is perhaps one of the most serious global health problems today, having the scale of a global pandemic, although not infectious in nature. Arterial hypertension is easily diagnosed and treated, and despite this, according to existing data, the frequency of its detection is 8-18%. Malignant hypertension is one of the most common causes of death in economically developed countries with a high standard of living (4-5% of deaths). At the same time, many patients may have diagnosed hypertension and not observe any signs of the development of pathology for many decades. Based on such cases, arterial hypertension is divided into benign and malignant types.

Hypertension is a chronic disease, the main symptomatic manifestation of which is a regular and prolonged increase in blood pressure (arterial hypertension). Fluctuations in the patient's blood pressure depend on many factors, such as living conditions, age, gender, medical indicators, etc. diastolic pressure, according to which arterial hypertension is understood as a long and steady increase in blood pressure:

Systolic - >140 mm. mercury column;
Diastolic - >90 mm. mercury column.

There are two types of hypertension.

benign type

Benign hypertension is characterized by a moderate course and mild clinical manifestations, with a gradual and slow change in the level of blood pressure (the level of “lower”, diastolic pressure is at the optimal level - not exceeding 120 mm Hg). Despite the slow development of the pathology, the patient will still feel the consequences of the pathology, including physiological changes in the body, such as vascular or renal tissue sclerosis.

malignant type

Malignant hypertension is a rapidly progressive form of the disease. When talking about malignant hypertension, they talk mainly about particularly complex cases of the disease, characterized by a rapid and significant increase in art. pressure (diastolic pressure exceeds the optimal values) and a severe course of the disease, which leads to the death of the patient within 1-2 years.

Thus, malignant hypertension is an exceptional case of hypertension that stands out from the total number of cases of the disease. They can occur as a complication of hypertension, which initially proceeded benignly. One of the common reasons for such a complication is poor-quality and irregular treatment of pathology. Also of great importance are any changes in the body of an immunological nature, problems with blood clotting, the patient's constant intake of hormonal drugs, as well as smoking: statistics state that progressive hypertension occurs five times more often in smoking patients.

Symptoms of hypertension

Initially, hypertension is simply the fact of increased blood pressure, that is, one of the symptoms of a diagnosed disease. At the same time, in modern medical practice there is no effective way to determine the causes of hypertension, therefore, in the bulk (in 90% of cases), hypertension is stated as primary hypertension, that is, an independent pathology. In other cases, hypertension is included in the clinical picture of another disease. This form is called secondary or symptomatic arterial hypertension. Malignant arterial hypertension is a disease, the clinical picture of which is determined almost immediately. For this form of the disease, the following symptoms are characteristic:

serious damage to visual functions as a result of neuroretinopathy;
chronic renal failure;
hypertrophy of the heart muscle, against which heart failure also develops;
hemolytic anemia;
problems with the blood supply to the brain, leading to a gradual decrease in memory and dementia.

The damage to tissues, organs and parts of the body does not occur suddenly, but gradually: in some variants of the development of the disease, the disease affects the kidneys, in others - the heart, and thirdly - the brain, while this form of the development of the disease is not necessarily characterized as "severe" - with an ordinary, slow course of the disease, there will be the same symptoms and the same localization of the disease in a particular area.

Causes of benign and malignant hypertension

Changes in blood pressure without symptoms, that is, primary hypertension, may be characteristic of young patients, as well as children. In this case, malignant hypertension is usually observed. In this category of patients, numerous hidden pathologies can be observed, therefore, the attending physician, in order to identify the causes of hypertension, first of all should find out: do these patients have possible hidden kidney diseases, pathologies and disorders in the structure of the renal arteries, any genetic features of the structure of the kidneys, pyelonephritis, and in addition, whether patients have pheochromocytoma or congenital heart disease, since any pathology or feature of the body can underlie malignant hypertension.

At the same time, real medical practice can clearly demonstrate that young patients with malignant hypertension often show signs of a secondary form of disease, that is, symptomatic hypertension, indicating the presence of some underlying disease. This means that it is necessary to distinguish between cases of malignant hypertension the same forms of diseases as among arterial hypertension in general.

It should also be noted that the overall percentage of patients with malignant hypertension over the past ten years, according to the Therapeutic Institute, has decreased markedly: down to 0.5%. However, over the entire specified period, despite fluctuations in percentages, the percentage of secondary (symptomatic) hypertension did not change at all and remained at the same level, corresponding to 15%. These indicators indicate significant changes in the therapeutic field in recent years and an improvement in the effectiveness of the treatment of primary hypertension.

Diagnosis and treatment of complicated hypertension

Therapeutic procedures for the treatment of hypertension should begin as early as possible - the effectiveness of both the treatment itself and the further recovery process depends on this. A very common cause of complications of hypertension is just the delay of this process by patients.

So, diagnostic procedures include:

Healing procedures:

Prevention of all prerequisites for the development of arterial hypertension, as well as treatment of the main symptoms, if these factors are successfully identified. For example, in the presence of a tumor of the adrenal gland, it should be eliminated, if a zone of narrowing of the renal vessels is detected, they are replaced with a prosthesis, or vasodilatation is performed.
If the patient complains of feeling well, then in order to reduce possible complications, it is necessary to reduce the diastolic pressure to 110 mm. mercury column, this should be done within a day.
In the first stages of treatment, if the patient has very high blood pressure, or a sudden increase in pressure, then short-acting pharmaceutical drugs can be used as emergency measures: beta-blockers, calcium antagonist drugs, central drugs, etc.
Malignant arterial hypertension is a complex disease that is very rarely treatable with one or two antihypertensive drugs. In such cases, three antihypertensive drugs should be used. It is important that only long-term exposure substances (from 12 hours) should be prescribed for regular use. This guarantees a mild effect on blood pressure surges and makes it possible to take medications twice a day.

In conclusion, the vast majority of patients with benign hypertension die from cerebral hemorrhage, myocardial infarction, or heart failure. In 5%, the disease is complicated to a malignant form, after which they die from kidney failure. At the end of the 20th century, one in four patients diagnosed with malignant arterial hypertension died within a year. Only one person in a hundred could live more than five years. Arterial hypertension is a serious disease, the prevention of which is necessary for every person, while timely diagnosis and treatment are still a guarantee of patient survival.

Under the malignant form of hypertension understand this type of disease in which the systolic pressure exceeds 220 mm Hg. Art., diastolic - 125 mm Hg. Art., edema of the optic nerve develops, exudate appears in the fundus. With malignant hypertension, the patient develops dysfunction of the heart, brain and kidneys. Information about what a malignant variant of the course of hypertension is is important for everyone who suffers from high blood pressure.

The concept of malignant hypertension

The disease is quite rare. It affects approximately 1% of patients with high blood pressure. Basically, malignant hypertension occurs in people who have not been treated for the disease. Often a malignant form of pathology develops as a secondary disease.

Pathology affects men under 40 years of age. After the age of 60, the risk of getting sick decreases to almost zero. Malignant hypertension occurs against the background of glomerulonephritis, renal pathologies. Most patients do not know what it is - malignant hypertension and do not go to a specialist when they detect persistently elevated pressure. This aggravates the treatment and prognosis of pathology.

Causes of malignant hypertension

The disease can develop into a malignant form in the course of its development. The exact causes of the development of the disease have not yet been determined. It has been established that the trigger mechanism for malignancy of the disease is destructive processes in the cardiovascular system. The most likely cause of the development of pathology is stenosis (narrowing) of the renal arterial vessels.

Damaged kidneys produce a number of substances that are harmful to the body. These substances contribute to a constant increase in blood pressure. In this situation, the production of hormones that dilate blood vessels is disrupted.

Malignant hypertension develops as a result of such pathologies:

Pheochromocytoma, or inflammatory processes in the tissues of the adrenal glands. As a result of these processes, substances are formed in the body that cause a sharp and stable increase in blood pressure. The probability of developing malignant hypertension against the background of pheochromocytoma is about 50%.
Parenchymal pathologies of the kidneys.
. This is the name of the disorder of the blood vessels in the kidneys. The blood supply to the organ is gradually disturbed, while the blood flow to it decreases. The pressure in the kidneys decreases, they secrete toxic substances in large quantities.

There are such risk factors for the development of the degeneration of benign hypertension into malignant:

. Because of this addiction, there is a violation of the ability of blood vessels to expand and contract. All smokers are at risk of developing malignant hypertension.
Alcohol consumption. This substance causes sharp fluctuations in blood pressure. This negatively affects the condition of the heart and blood vessels. Ethanol contributes to the defeat of all organs. Patients who are at risk, it is important to completely abandon the use of any type of alcoholic beverages.
endocrine disorders.
Pregnancy. Malignant arterial hypertension can occur in women in the later stages of bearing a child.
Unfavorable genetic inheritance. A person has a high risk of developing hypertension if his relatives suffered from persistent high blood pressure.
Intense physical activity and overwork can cause a permanent increase in pressure. This is due to the fact that the body cannot adequately rest, which is why its vessels are constantly in a tense state.
Stress, psychological problems and emotional overload contribute to the growth of blood pressure. In some cases, they are elevated for a long time.
age factors.

Important! The presence of at least one predisposing factor contributes to the development of a malignant form of hypertension in a patient.

Signs of illness

Its insidiousness is that it may not manifest itself in the early stages. A person may find that he has become tired more often and quickly, he cannot perform the previous volumes of work. Nevertheless, it is difficult to establish the presence of a malignant form of hypertension in a patient on this basis alone. A person begins to use drugs to support immunity, strengthening compounds. They do not affect slowly progressive hypertension.

As it develops, the disease signals the following signs:

double vision and blurred vision;
blurred vision;
the appearance of sudden and severe pain in the head of varying degrees of intensity;
severe weakness, combined with a sharp drop in labor productivity;
sudden weight loss (provided that the daily diet of a person does not change);
development of edema (as a result of dysfunction of the kidneys and adrenal cortex);
the occurrence of syncope;
temporary complete loss of vision;
violation of normal blood circulation, which manifests itself in a feeling of constant cold (or heat) in the limbs;
bleeding disorders (it leads to an increased risk of blood clots);
nausea, vomiting, dyspepsia;
sharp;
jumps in body temperature;
the appearance of pain behind the sternum (they intensify after physical activity);
sleep problems;
a change in the shade of the face (malignant arterial hypertension leads to the fact that it becomes gray, earthy);
decrease in memory and concentration, other symptoms of a disorder of higher nervous activity;
uncontrolled increase in tonometer readings without signs of self-stopping of the arterial crisis;
an increase in the abdomen as a result of edema.

Note! The appearance of at least one of the symptoms described above is an indication for immediate medical attention and a set of diagnostic measures.

Features of the diagnosis of the disease

The specialist necessarily sends the patient for examination when signs of a malignant course of hypertension appear.

The most important step in the diagnosis is the collection of anamnesis. It helps to clarify the features of a person's lifestyle, the duration of the pathology. To clarify the diagnosis, the doctor conducts a visual examination of the patient, measures the pressure. An increase in systolic and diastolic values above 110 mm indicates a high probability of malignant hypertension.

The following diagnostic methods are clinically important:

blood tests - general and biochemical;
electrocardiography;
ultrasound examination of the esophagus, stomach and duodenum;
ultrasound examination of the thyroid gland and heart;
ultrasound examination of the retroperitoneal space;
computed or magnetic resonance imaging (possible use of a contrast agent);
daily monitoring of urination;
echocardiography;
daily measurement of blood pressure;
lung capacity test.

The patient needs to consult an ophthalmologist, cardiologist, neurologist, nephrologist, endocrinologist. Specialists of a narrow profile detect disorders that develop against the background of a malignant course of hypertension.

Treatment

The considered form of pathology develops extremely quickly. Treatment of malignant hypertension should begin from the first days of detection of a dangerous pathology. This will prevent the development of dangerous complications, due to which all internal organs suffer. Therapy for a malignant form of hypertension begins with the elimination of its cause.

Medical treatment

An obligatory part of the treatment of a malignant form of hypertension is taking medications. The doctor prescribes several drugs with a similar effect. The patient is prescribed drugs of the following groups:

Before choosing a drug, the doctor assesses the degree of development of the pathological process and the nature of the increase in blood pressure. Kidney function, heart rate and its correctness should be taken into account. The criterion for the effectiveness of antihypertensive treatment is a decrease in tonometer readings by ¼ from the current ones.

If by that time a person does not develop adverse reactions to the medications taken, he does not have a deterioration in his health, then you can proceed to a further decrease in the level of blood pressure.

Therapy of a malignant form of hypertension is associated with the prevention of the risk of developing damage to other organs. For this, the patient's treatment regimen will consist of the following medications:

ACE inhibitors;
calcium antagonists;
beta blockers;
diuretics;
calcium channel blockers.

If necessary, treatment is supplemented by other methods. So, with the development of renal failure, the patient undergoes hemodialysis or hemofiltration. With severe edema, isolated renal ultrafiltration is used. If these methods are ineffective, then the issue of kidney transplantation is decided.

Non-drug therapy

The use of drugs alone often does not bring the desired effects. Therefore, other therapies need to be introduced. Its principles are quite simple:

body weight correction;
the use of calcium, magnesium and potassium - minerals necessary for the normal functioning of the heart and blood vessels;
quitting smoking and drinking alcohol;
limiting the consumption of animal fats;
motor activity correction.

Important! If these methods of treatment do not improve the patient's condition, the issue of surgical treatment of the disease is decided. The most common is coronary artery bypass grafting. In the presence of tumors of the kidneys, thyroid gland, adrenal glands, they are resected.

Consequences of the malignant form

If he does not treat his illness or does it incorrectly, he may develop such life-threatening complications.

Apoplexy (stroke). It is the most common consequence of the disease. Stroke leads to disability of the patient and often to death.
Blindness. It develops due to detachment of the retina of the eye. The patient may also lose vision due to progressive damage to the optic nerve.
Impaired blood supply to the kidneys. This complication can cause a heart attack or organ necrosis. These conditions lead to the development of acute and chronic kidney failure.
Ischemic heart disease, which develops against the background of a decrease in blood supply to the heart muscle. It leads to the development of a myocardial infarction in a patient.

Pathology prognosis

Doctors are trying to develop and put into practice such methods of therapy that would reduce the likelihood of a patient developing severe complications. The current therapeutic methods allow patients to live for more than 5 years with an unfavorable prognosis.

Attention! In the absence of professional assistance, patients develop acute heart and kidney failure. A lethal outcome in this case is possible within six months. 20% of these patients are at risk of dying within one year of the onset of pathology without adequate therapy.

Recovery is determined by the timeliness and effectiveness of antihypertensive treatment. The earlier treatment is started, the better its outcome and the higher the likelihood of maintaining a person's working capacity. A favorable outcome is guaranteed in approximately 90% of cases, provided that effective treatment of the pathology is started early and the patient complies with all medical recommendations.

Prevention

Prevention is aimed at a general decrease in the body, the exclusion of the impact on it of predisposing factors and the normalization of blood pressure. Preventive measures include:

the fight against obesity;
normalization of the level of glycemia;
treatment of comorbidities;
quitting smoking and drinking alcohol;
constant monitoring of blood pressure;
taking medications prescribed by a doctor to correct tonometer readings.

Malignant hypertension is a dangerous form of the disease. It requires timely treatment and the patient's implementation of all recommendations for a healthy lifestyle. This contributes to recovery and prevention of the development of dangerous complications.