eMedicine Specialties > Nephrology > Hypertension and the Kidney

Hypertension, Malignant: Follow-up

Author: John D Bisognano, MD, PhD, FACP, FACC, Associate Professor, Director of Outpatient Cardiology, Department of Medicine, Cardiology Division, University of Rochester Medical Center
Contributor Information and Disclosures

Updated: Sep 15, 2009

Follow-up

Further Inpatient Care

  • Patients with hypertensive emergencies should be admitted to the hospital for close hemodynamic monitoring and administration of IV antihypertensive medications.
  • Secondary causes of hypertension should be investigated.
  • Oral medications should be initiated as soon as possible in order to ease transition to an outpatient setting.

Further Outpatient Care

  • The best way to prevent further episodes of hypertensive emergencies is to ensure that the patient has close outpatient follow-up for hypertension treatment. This can usually be accomplished by a general medicine or family practice physician, but referral to a hypertension specialist should also be considered for patients who require complex drug therapy or additional secondary workup.

Complications

  • Overzealous reduction of blood pressure can result in organ hypoperfusion.
  • In a hypovolemic patient, enalapril has an unpredictable response with a possible uncontrolled drop in blood pressure.
  • Target organ damage can be missed without a thorough evaluation.

Prognosis

  • Prior to effective therapy, life expectancy was less than 2 years, with most deaths resulting from stroke, renal failure, or heart failure. The survival rate at 1 year was less than 25% and at 5 years was less than 1%.
  • With current therapy, including dialysis, the survival rate at 1 year is greater than 90% and at 5 years is 80%. The most common cause of death is cardiac, with stroke and renal failure also common.

Patient Education

  • Patients must be taught an appropriate diet for long-term management.
  • Upon discharge, patients should know the signs and symptoms that should prompt immediate notification of a physician.
  • Upon discharge, patients should know the proper dosing and adverse effects of their medications.
  • For excellent patient education resources, visit eMedicine's Diabetes Center. Also, see eMedicine's patient education article High Blood Pressure.

Miscellaneous

Medicolegal Pitfalls

  • Reducing blood pressure too rapidly can result in patient harm.
  • Properly diagnosing hypertensive emergency and urgency is essential to proper triage and treatment.
  • All patients should be carefully assessed for secondary causes of hypertension.
  • Upon discharge, patients should have close follow-up care. They should know the signs and symptoms that necessitate immediate notification of a physician.
 
Acknowledgments

We would like to thank Alexander N Orsini, MD, for his previous contributions to this article.



More on Hypertension, Malignant

Overview: Hypertension, Malignant
Differential Diagnoses & Workup: Hypertension, Malignant
Treatment & Medication: Hypertension, Malignant
Follow-up: Hypertension, Malignant
Multimedia: Hypertension, Malignant
References
Further Reading
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References

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Further Reading

Related eMedicine topics:
Encephalopathy, Hypertensive
Hypertension [Nephrology]
Hypertension [Ophthalmology]
Hypertension [Pediatrics: Cardiac Disease and Critical Care Medicine]
Hypertensive Emergencies
Ocular Hypertension
Papilledema
Pseudopapilledema

Clinical guidelines:
ACR Appropriateness Criteria® renovascular hypertension. American College of Radiology - Medical Specialty Society. 1995 (revised 2007). 9 pages. NGC:006003

American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of hypertension. American Association of Clinical Endocrinologists - Medical Specialty Society. 2006 Mar-Apr. 30 pages. NGC:005007

Clinical trials:
Single Incision Laparoscopy (SIL)

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Keywords

malignant hypertension, hypertensive emergency, hypertension, high blood pressure, metoprolol, verapamil, diltiazem, labetalol, papilledema, hydralazine, nitroprusside, hypertensive, hypertensive urgency, phentolamine, hypertensive encephalopathy, accelerated hypertension, fibrinoid necrosis of arterioles and small arteries, microangiopathic hemolytic anemia, elevated blood pressure

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Contributor Information and Disclosures

Author

John D Bisognano, MD, PhD, FACP, FACC, Associate Professor, Director of Outpatient Cardiology, Department of Medicine, Cardiology Division, University of Rochester Medical Center
John D Bisognano, MD, PhD, FACP, FACC is a member of the following medical societies: American College of Cardiology and American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

L Michael Prisant, MD, FACC, Director of Hypertension and Clinical Pharmacology Unit, Professor of Medicine, Department of Medicine, Medical College of Georgia
L Michael Prisant, MD, FACC is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Clinical Pharmacology, American College of Forensic Examiners, American College of Physicians, American Heart Association, and American Medical Association
Disclosure: Abbott Grant/research funds Investigator; Boehringer-Ingelheim Grant/research funds Other; Eli Lilly None Investigator; Novartis None Investigator; Abbott, Boehringer-Ingelheim, Forest, Gilead, Merck, Merck/Schering-Plough, Novartis, Oscient, Sciele, SunTech Medical Consulting fee Consulting; Abbott, Boehringer-Ingelheim, Merck, Merck/Schering-Plough, Novartis, Oscient Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

George R Aronoff, MD, Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine
George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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