Severe hypertension >200/120 mm Hg with retinal haemorrhages, exudates & papilledema Most severe form of hypertension

diagnostic criteria

Defined clinically diastolic >130mmHg + bilateral retinal haemorrhages &/or exudates with papilledema (hypertensive retinopathy grade III or IV according to classification of Keith, Wagner and Barker.)

“more modern” diagnostic criteria: hypertensive emergency in the absence of retinopathy based on acute elevated BP and impairment of at least 3 different target organs (kidney, heart, brain, microangiopathy) ∴ malignant hypertension = clinical presentation of hypertension with multiorgan damage

Clinical features

Grade 4 hypertensive eye disease + headaches, eye pain, reduced visual acuity and focal neurological deficits

History Meds: cocaine, MAOIs, oral contraceptives,

Withdrawal: beta blockers, alpha stimulant or alcohol

Examination

Cardio

• angina +/- MI, CCF, pulmonary oedema
• orthostatic symptoms
• S4 (LVH and dilation)

CNS

• occipital headache
• cerebral infarction/haemorrhages
• visual disturbance