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Malignant Hypertension — RACP Adult Medicine MCQ

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ModerateCardiologyMalignant HypertensionRACP Adult Medicine

A 55-year-old man presents with severe headache, BP 240/140 mmHg, papilloedema (Grade IV hypertensive retinopathy), and creatinine rising from 100 to 250 μmol/L over 24 hours. Urinalysis shows haematuria and proteinuria. Blood film shows schistocytes. LDH is elevated. What is the most likely diagnosis?

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Correct answer: A — Malignant hypertension (hypertensive emergency with end-organ damage)

BP ≥180/120 with acute end-organ damage (papilloedema, AKI, microangiopathic haemolysis with schistocytes) is malignant hypertension/hypertensive emergency. Management: IV antihypertensive infusion (labetalol, GTN, or sodium nitroprusside) with controlled reduction — target 25% reduction in MAP over the first hour, then gradually to 160/100 over 2-6 hours. Overly rapid reduction causes watershed ischaemia (stroke, MI, renal cortical necrosis).

Reference: NHFA – 2016 – Hypertension; ESC 2024 Hypertension