[临床医学]Malignant Hypertension and Other Hypertensive Crises.ppt

MHP and Other Hypertensive Crises Diseases of the Kidney Urinary Tract The Clinical Spectrum of Severe Hypertension The vast majority of hypertension are asymptomatic for many years until atherosclerosis, cerebrovascular disease, congestive heart failure develop. In 1% of patients this “benign” course is punctuated by a hypertensive crisis. Hypertensive crisis Hypertensive crisis is defined as the turning point in the course of an illness at which acute management of the elevated BP plays a decisive role in the eventual outcome. ---- The crucial role of hypertension in the disease process must be identified and a management must be successfully implemented. The absolute level of BP is not the most important factor in determining a hypertensive crisis. ---- In children, pregnant women, previously normotensive individual, a hypertensive crisis can occur if moderate hypertension develops suddenly. MHP(accelerated hypertension ) MHP is a clinical syndrome characterized by marked elevation of BP with widespread acute arteriolar injury. Funduscopy reveals hypertensive neuroretinopathy视神经视网膜病 : 1,striate (flame-shaped) hemorrhages, 2,cotton-wool (soft) exudates, 3,papilledema. Regardless of the degree of BP elevation, MHP cannot be diagnosed in the absence of hypertensive neuroretinopathy. Hypertensive neuroretinopathy is an extremely important clinical finding that indicates the presence of a widespread hypertension-induced arteriolitis which may involve the central nervous system, heart, and kidneys. Hypertensive encephalopathy Hypertensive encephalopathy: cerebral malfunction is attributed to the severe elevation of BP. It can also occur in MHP or in the absence of neuroretinopathy. Hypertensive encephalopathy can develop in the setting of severe hypertension of any cause ----- eclampsia, acute glomerulonephritis, pheochromocytoma, or drug withdrawal hypertension. Clinical features: severe