How are malignant hypertension and accelerated hypertension characterized in hypertensive emergencies?

Updated: Feb 05, 2018
  • Author: Christy Hopkins, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Malignant hypertension and accelerated hypertension are both hypertensive emergencies (ie, systolic BP [SBP] >180 mm Hg or diastolic BP [DBP] >120 mm Hg, and acute target organ damage [10] ), with similar outcomes and therapies. Malignant hypertension may or may not be associated with clinical conditions present in hypertensive urgency (ie, SBP >180 mm Hg or DBP >120 mm Hg, but no evidence of acute target organ damage [10, 11] ; thus, hypertensive urgency occurs in the absence of acute end-organ damage, whereas hypertensive emergencies include the presence of acute end-organ damage [11, 12] ).

A patient with malignant hypertension always has retinal papilledema (as seen in the image below), [13] as well as flame-shaped hemorrhages and exudates. Other clinical features of malignant hypertension may include encephalopathy, confusion, left ventricular failure, intravascular coagulation, and impaired renal function, with hematuria and weight loss.

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