Sunday, February 1, 2015

Study group discussion: Malignant hypertension

What the difference between essential & malignant hypertension?

Essential is of unknown cause. Also known as the primary hypertension.
Malignant hypertension is also known as hypertensive emergency.

Malignant hypertension is an acute form that effects one or more organ systems.
Cardiovascular system, central nervous system and renal systems are irreversibly damaged.

Also papilledema! Remember reading it in ophthalmology.

In malignant hypertension, BP shd be lowered asap with antihypertensive agents. Mostly, iv injection of sodium nitroprusside is given for immediate effect so that BP is lowered.

There was also something about nitroglycerin and nitroprusside.. Which should be used when in malignant hypertension.
Don't remember what it was.. Like if cerebral edema is more use this stuff and if some other symptom is more you'll use the other one of the two.

Just read it up.. They say you choose based on the end organ damage.
Nitroprusside is widely used, especially if the person has neurological symptoms, cerebral edema.
Nitroglycerine will be the drug of choice if the heart is involved (Ischemia, acute coronary syndrome)

I'll have to correct myself, nitroglycerin isn't used anymore in hypertensive emergencies because of the side effect profile. If used, it's used as an adjunct.

Read a ncbi article on the same: Nitroglycerin is a potent venodilator, and only at high doses does it affect arterial tone. It causes hypotension and reflex tachycardia, which are exacerbated by the volume depletion characteristic of hypertensive emergencies. Nitroglycerin reduces blood pressure by reducing preload and cardiac output, which are undesirable effects in patients with compromised cerebral and renal perfusion. Low dose (60 mg/min) nitroglycerin may, however, be used as an adjunct to intravenous antihypertensive therapy in patients with hypertensive emergencies associated with acute coronary syndromes or acute pulmonary edema.

*After a lot of unsure discussions on hypertensive emergency, hypertensive urgency and malignant hypertension we concluded this*

Emergency: End organ damage.
Urgency: No end organ damage.

Malignant hypertension = Hypertensive emergency.

Hypertensive crisis: Severe elevation in blood pressure, with diastolic blood pressure (DBP) > 120-130 mmHg.

Nitroprusside is given in hypertensive emergency. However, watch out for cyanide toxicity when you choose to administer it.

Got a revision question! Which drug is used in cyanide toxicity?

Sodium thiosulphate.
Cyanide toxicity - GTN.


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