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Malignant Hypertension — RACP Adult Medicine MCQ

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HardCardiologyMalignant HypertensionRACP Adult Medicine

A 42-year-old has blood pressure 240/140 mmHg, papilloedema, acute kidney injury and microangiopathic haemolysis. What is the immediate blood-pressure strategy?

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Correct answer: D — Use a titratable IV antihypertensive with monitored, controlled initial reduction rather than immediate normalisation

The best answer is “Use a titratable IV antihypertensive with monitored, controlled initial reduction rather than immediate normalisation”. This is a hypertensive emergency with retinal, renal and haematological end-organ injury. A titratable IV drug and high-acuity monitoring allow an initial mean arterial pressure reduction of roughly 20–25%, followed by slower lowering, avoiding cerebral, coronary and renal ischaemia. Abrupt normalisation and unmonitored short-acting agents are dangerous.

Reference: Heart Foundation: Guideline for diagnosis and management of hypertension: https://www.heartfoundation.org.au/getmedia/c83511ab-835a-4fcf-96f5-88d770582ddc/PRO-167_Hypertension-guideline-2016_WEB.pdf