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Malignant Hypertension — ESENeph MCQ

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ModerateHypertensionMalignant HypertensionESENeph

A 50-year-old man has a BP of 210/120 mmHg with papilloedema, creatinine of 350 umol/L, and haematuria. He has had untreated hypertension for years. Blood film shows fragmented red cells. What is the appropriate rate of initial BP reduction?

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Correct answer: A — Reduce mean arterial pressure by no more than 25% in the first hour; then gradually to 160/100 over the next 2-6 hours

Malignant hypertension with papilloedema and end-organ damage (AKI, TMA) is a hypertensive emergency requiring IV antihypertensive therapy (e.g. IV Labetalol or sodium nitroprusside). The recommended approach is to reduce MAP by no more than 25% in the first hour, then gradually to 160/100 mmHg over the next 2-6 hours. Rapid overcorrection risks watershed cerebral infarction, especially in patients with chronic hypertension and shifted autoregulatory curves.

Reference: ESC/ESH 2018 – Hypertension Guidelines; NICE NG136 2019 – Hypertension