Treatment of malignant hypertension
Malignant hypertension is an emergency condition that requires admission to an intensive care unit (ICU). The doctors will use intravenous antihypertensive medications to lower blood pressure to a safe level. Then, they will use oral antihypertensive medications.
The doctors should consider that patients with malignant hypertension have weak blood pressure-regulating mechanisms. Thus, they should lower blood pressure to the desired level gradually to avoid hypotension.
⇒ Thus, our goal will be the gradual reduction of blood pressure to a safe level. We will do that as the following:
Initially, we will reduce blood pressure by less than 25% within the first 24-48 hours. If the patient remains stable, we will target a blood pressure 160/110 mmHg within the next 6 hours. After these reductions, if the patient remains stable, we will switch him to oral antihypertensive medications to lower blood pressure to the normal range within the next 24-48 hours.
To treat malignant hypertension as the previous way, we can use different classes of antihypertensive medications, such as:
- Calcium channel blockers (ex, diltiazem- verapamil): they lower blood pressure regularly and safely by lowering the vascular resistance. They also reduce the risk of heart failure by lowering heart rate.
- Beta-blockers (ex, labetalol- esmolol- metoprolol): they lower blood pressure by blocking catecholamines’ action (adrenaline and noradrenaline). They also reduce the risk of heart failure by lowering heart rate. We can easily switch the labetalol from the intravenous form to use it orally.
- Vasodilators (ex, sodium nitroprusside): they lower blood pressure by dilating the blood vessels. The doctors commonly use these medications intravenously but cautiously due to a rapid, severe drop in blood pressure.
♦ For pregnant females: the first choice drug is the alpha-methyl dopa.
♦ In pheochromocytoma: phentolamine is the drug of choice because it blocks the effect of adrenaline and noradrenaline.
After reducing blood pressure to a safe level, doctors will direct the treatment towards your symptoms and try to reverse any organ damage. For example, if there is renal failure, you will need kidney dialysis (artificial blood filtration). If there are treatable causes of malignant hypertension, the doctors should consider it in the treatment plan.
- You should know that malignant hypertension is preventable, and the patients can reduce the risk of malignant hypertension and its life-threatening complications.