Common symptoms of malignant hypertension
Historically, what were the common clinical features of malignant hypertension?
Typically the blood pressure was very high (often diastolic >140 mm Hg). The optic fundi showed bilateral papilledema, often with hemorrhages and exudates in the periphery. Hypertensive encephalopathy was common, usually preceded by headache, somnolence, visual changes, and confusion. Microangiopathic hemolytic anemia, with schistocytes and helmet cells on peripheral smear, and increased serum lactate dehydrogenase often were associated with fibrinoid necrosis of arterioles. Normal kidney function was distinctly unusual; most patients had oliguria, azotemia, proteinuria, and (usually microscopic) hematuria. The major reason malignant hypertension is uncommon today is that, in early studies, even a single antihypertensive drug reduced the risk of malignant hypertension by more than 90%.
