Bosisio Francesca Gaia, Mingardi Desirè, Moretti Elisabetta, Muzi Giorgia, Russomanno Francesco, Tassani Nicola, Stassaldi Deborah, Agabiti Rosei Claudia, De Ciuceis Carolina, Salvetti Massimo, Muiesan Maria Lorenza
UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy.
Emergency Medicine ASST Spedali Civili Brescia, Brescia, Italy.
Front Cardiovasc Med. 2023 Jan 13;9:1108666. doi: 10.3389/fcvm.2022.1108666. eCollection 2022.
Malignant hypertension (MH) is characterized by severe hypertension (usually grade 3) associated with fundoscopic changes (flame hemorrhages and/or papilledema), microangiopathy and disseminated intravascular coagulation. In addition encephalopathy, acute heart failure and acute deterioration in renal function may be present. The term "malignant" reflects the very poor prognosis for this condition if untreated. When severe hypertension is associated with hypertension-mediated organ damage (HMOD) a life-threatening situation that requires immediate but careful intervention occurs (hypertensive emergency). In the last few years an increase in the number of patients with malignant hypertension has been observed, especially among those patients with black ethnicity. Limited access to treatment and the poor adherence to anti-hypertensive therapy may contribute to the development of hypertensive emergencies. It is considered appropriate to study patients in order to rule out thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. In fact, the microvascular damage caused by malignant hypertension can favor intravascular hemolysis like Thrombotic Microangiopathies (TMs). TMs may present in three different clinical conditions: typical hemolytic uremic syndrome (HUS), atypical hemolytic uremic syndrome (aHUS) and thrombotic thrombocytopenic purpura (TTP). TMs can arise in the context of other pathological processes, including malignant hypertension.
恶性高血压（MH）的特征是严重高血压（通常为3级），伴有眼底改变（火焰状出血和/或视乳头水肿）、微血管病和弥散性血管内凝血。此外，可能存在脑病、急性心力衰竭和肾功能急性恶化。“恶性”一词反映了这种疾病若不治疗预后极差。当严重高血压与高血压介导的器官损害（HMOD）相关时，就会出现需要立即但谨慎干预的危及生命的情况（高血压急症）。在过去几年中，观察到恶性高血压患者数量有所增加，尤其是在黑人种族患者中。治疗机会有限和对抗高血压治疗的依从性差可能导致高血压急症的发生。为排除血栓性血小板减少性紫癜和溶血性尿毒症综合征而对患者进行检查被认为是合适的。事实上，恶性高血压引起的微血管损伤可促进血管内溶血，类似于血栓性微血管病（TMs）。TMs可出现在三种不同的临床情况中：典型溶血性尿毒症综合征（HUS）、非典型溶血性尿毒症综合征（aHUS）和血栓性血小板减少性紫癜（TTP）。TMs可在其他病理过程中出现，包括恶性高血压。
