What is hypertensive encephalopathy?

Updated: Dec 10, 2018
  • Author: Irawan Susanto, MD, FACP; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

The term hypertensive encephalopathy was introduced in 1928 to describe the encephalopathic findings associated with the accelerated malignant phase of hypertension. The terms accelerated and malignant were used to describe the retinal findings associated with hypertension, as follows:

  • Accelerated hypertension is associated with group 3 Keith-Wagener-Barker retinopathy, which is characterized by retinal hemorrhages and exudates on funduscopic examination

  • Malignant hypertension is associated with group 4 Keith-Wagener-Barker retinopathy, which is characterized by the presence of papilledema, heralding neurologic impairment from an elevated intracranial pressure (ICP)

With adequate control of hypertension, less than 1% of patients experience a hypertensive crisis. A hypertensive crisis is classified as either a hypertensive emergency or a hypertensive urgency, [1] as follows:

  • Acute or ongoing vital target organ damage (eg, damage to the brain, kidney, or heart) in the setting of severe hypertension is considered a hypertensive emergency; a prompt reduction in blood pressure is required within minutes or hours

  • The absence of target organ damage in the presence of a severe elevation in blood pressure (with diastolic blood pressure frequently exceeding 120 mm Hg) is considered a hypertensive urgency; a reduction in blood pressure is required within 24-48 hours

A continuum exists between the clinical syndromes of hypertensive urgency and emergency; hence, the distinction between the 2 syndromes may not always be clear and precise in practice. [2]

Hypertensive encephalopathy refers to the transient migratory neurologic symptoms that are associated with the malignant hypertensive state in a hypertensive emergency. The clinical symptoms are usually reversible with prompt initiation of therapy. In the evaluation of an encephalopathic patient, it is vital to exclude systemic disorders and various cerebrovascular events that may present with a similar constellation of clinical findings.


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