PP.29.27: FROM MALIGNANT HYPERTENSION TO HYPERTENSION-MOD. (June 2015)

• Record Type: Journal Article
• Authors: Gosse, P.; Cremer, A.; Amraoui, F.; Lip, G.; Morales, E.; Rubin, S.; Segura, J.; Van Den Born, B.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000468619.68444.40
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: The prevalence of malignant hypertension has clearly fallen with the advent of anti-hypertensive medication but has remained relatively stable over the last 30–40 years in spite of medical progress in diagnosis and management of hypertension. At present, a diagnosis of malignant hypertension is based on the association of severely elevated BP with a Keith and Wagener stage III or IV retinopathy. We believe that this definition can be reconsidered for several reasons. Whilst simple and pragmatic, this definition corresponds to a time when there were few techniques for assessment of hypertensive target organ involvement, and does not take into account involvement of kidney, brain and heart, whereas the overall prognosis largely depends on how much they are affected. On the contrary, the acute blood pressure level and especially diastolic should not be a hard diagnostic criterion as it does not itself constitute the prognosis of the condition. Design and method: Consensus from a working group on 'malignant' hypertension. Results: We propose to consider that Malignant hypertension with retinopathy is only one of a number of possible presentation(s) of acute hypertension with Multi Organ Damage (Hypertension-MOD) and that the recognition of these hypertensive emergencies, when retinopathy is lacking, be based on acute elevation of BP associated with impairment of at least three different target organs as summarized in the following table: Figure. No caption available. LVH: left ventricular hypertrophy, LVMI left ventricular mass index, EF: ejection fraction, GLS: global longitudinal strain, PRES: Posterior reversible encephalopathy syndrome. The objective of a re-definition of malignant hypertension, to expand its scope, is to facilitate recognition of these true emergencies by the medical community. The condition is more common than usually perceived and would have a much worse prognosis than the usual forms of hypertension. Conclusions: Early recognition and management of hypertension-MOD are fundamental to any improvement in prognosis., and we feel that a more up to date expanded definition would enable recognition of these forms of hypertension which are currently overlooked in the published recommendations. Prospective evaluation of these criteria is mandatory and should involve prospective multicenter studies.