Malignant Hypertension - after Half a Century: from Therapeutic Nihilism to Effective Treatment

Abstract

Malignant hypertension is the most severe form of arterial hypertension.The incidence of this type of hypertension is less than 1% in general hypertensive population. Malignant hypertension is characterized by widespread vascular changes — fibrinoid necrosis and subintimal cellular proliferation. The pathogenesis of malignant hypertension is not fully elucidated. Most widely accepted opinion is that increased blood pressure is the primary most important event.However,other humoral factors as renin,angiotensin II,aldosterone,vasopressin,endothelin,coagulation factors and genetic factors may be involved. Development of effective hypotensive drugs in the last decades has changed the natural history of the disease and has markedly improved prognosis.